Physician Use of the Internet

Posted on May 10, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

The Slow Evolution of a Healthcare Tool

[By Carol S. Miller; RN, MBA]

The Internet is a constantly evolving service that continues to grow at an exponential rate, especially in physician practices. Primarily, the Internet is used as a means to electronically and expeditiously transfer data via e-mail as well as obtain information from a variety of sites. Initially, in the physician’s office, the primary use was e-mail communications with peers, hospitals and others. Next providers linked to hospitals and managed care organizations to obtain more direct connectivity for clinical information and benefit coverage. Today physicians are finding other beneficial avenues to expand their utilization of the Internet. Several examples include:

Direct e-mail inquiries from the patient to the physician.
Patient educational newsletters and links to other healthcare educational web sites.
Continuing medical education (CME).
Chat room consultations, conferences or presentations with other providers.
Nurse to patient e-mail connectivity.
Immediate data on lab results with alerts for abnormal high or low values.
CPOEs (Computerized Purchase Order Entry Systems).
Radiology images.
EMR (Electronic Medical Records).
Monitoring of patients blood sugars or EKGs via the Internet.
Appointment scheduling on-line by patients.
Patient appointment reminders via the Internet.
Secure physician portals such as Medicity, located at www.medicity.com, which allows access to pertinent and prioritized data from a wide range of sources and vendors to include, labs, imaging centers, hospitals, payers and others.
HIPAA compliant Application Service Providers (ASP) for dictation, recording, routing and speech recognition and transcription services, such as Speech Machines at http://www.speechmachines.com.

Access Management

Besides the value to the patient and the physician, the physician can utilize his or her Internet connection with software firms such as NextGen to automate the registration, scheduling, eligibility verification, billing and “clean” claims processing via innovative Web-base solutions in real-time scenarios. All the physician’s office needs is a PC, a standard Internet browser, and a connection to the Internet to take advantage of this service.

Assessment

These resources and more, via the Internet super highway, enable physicians to have quicker and easier access to clinical information and improve productivity. Furthermore, these tools will quickly assist providers with accurate and timely medical decision making, thus improving patient care and outcomes.

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

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Non-Traditional Property and Liability Insurance Coverage for Doctors

Posted on May 9, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Review of Other Insurance Forms for Medical Providers

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chief

Obviously, not all forms of P and L insurance coverage can be described in detail on this post. However, the healthcare professional or medical practitioner should consider these other forms of commercial property and liability coverage.

Directors and Officers Liability Insurance

The officers and directors of large practices, or healthcare facilities can be held personally accountable, and thus liable, for breaches of their duties by a number of parties.

Commercial Automobile / Vehicle Insurance

As the name suggests, this coverage provides protection for any commercial vehicles owned and operated by the healthcare corporation. If the practice or facility owns automobiles or other vehicles that are used in the “usual and customary” business activities, this coverage is required. The policy-owner should be aware of the nine classifications of automobiles insured to ensure that coverage is appropriate.

Commercial Umbrella Liability Insurance

This coverage is very similar to the umbrella coverage that falls under the personal coverage area. Again, risks above the limits established by the underlying commercial liability coverage trigger the umbrella policy. The word of caution for this coverage is “Read the Provisions Carefully” as there is little standardization among insurance companies. Make sure the umbrella policy covers what you want it to cover, with the right limits of benefits and “trigger” points, with proper exclusions, and proper endorsements (if being used specifically for a medical practice.)

Employee Benefits Liability Insurance

Virtually each medical practice or healthcare facility has employee non-cash benefits in addition to their payroll. These benefits usually include group insurance and some form of retirement plan (a 401(k), for example). Nevertheless, each of these benefit packages expose the employer to liabilities under state and federal statutes. Employee Benefits Liability Insurance covers an employer, or if so stipulated by some policies, the employees who act on behalf of the employer, against liability claims involving alleged errors or omissions, or improper advice or administration of the employee fringe benefit plans. For example, an employer may be liable for not enrolling an employee on a timely manner resulting in no medical coverage. Frequent litigation also arises out of violations of the Employee Retirement Income Security Act (ERISA) of 1974. Since 1974, the provisions and reach of this Act has become massive and errors can occur.

Disclaimer: The author is a former licensed insurance agent and certified financial planner and advisor.

Conclusion

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ADSL – DSL Primer for Physicians

Posted on May 8, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Asynchronous Data Subscriber Line versus Digital Subscriber Loop

By Carol S. Miller; RN, MBA

Asynchronous Data Subscriber Lines

ADSL is a very fast digital line provided by the telephone company. If available in your area, the ADSL provides fast connections, but generally not as fast as cable. There are various choices, beginning around 256 kbps (about five to six times the speed of a fast modem) going up to 7 Mbps. Prices begin around $60 per month (including Internet service). There is also a set-up charge and a card needs to be inserted in your computer.

Digital Subscriber Lines

DSL is a high-speed direct line that can be 20-100 times faster in communication over the modem, depending on the type selected. Prices for the DSL begin at approximately $30-$40 per month and that includes Internet access. In addition, there is a set-up charge and a network card will need to be installed into the computer. Office workstations can usually share DSL circuits over their existing local area network (LAN).

Internet Connection

To connect with the Internet, as a rule of thumb, the faster the better; therefore, the office should have at least 56 kbps. DSL normally runs over the same line as a basic telephone voice circuit and provides Internet access from speeds of 384 kbps all the way up to 1.54 mbps (megabits per second). The advantage of this configuration is you not only have high-speed access to the Internet, your telephone is still free to make and receive calls at the same time.

Integrated Services Digital Network

A digital telephone line that allows voice and data to be transmitted on the same line in a digital format – instead of analog – and at a relatively high speed, usually around 64 to 128 kbps. When reviewing this service, make sure the ISP has an ISDN connection. If not, you will be charge more by both the telephone company and the ISP. Prices for the ISDN average around $300 plus, with an extra fee to install the telephone line and a monthly service charge of $25 to $100 plus to maintain.

Wireless Network (WiFi – 802.11b)

The biggest change to happen to computers in the last ten years has undoubtedly been the Internet. Close on its heels in importance may just be the adoption of the wireless network access. Wireless Fidelity, or Wi-Fi, is now cost effective and available at the computer store. It is no longer necessary to re-wire buildings with Category 5 wire to provide LAN connectivity and resource sharing to multiple computers. Wi-Fi, or IEE standard 802.11b, enables small offices to connect up to four computers to a single network for less than the cost of a single computer. This means the days of multiple analog lines to offer Internet access to every computer, or a printer on every desktop, are going away. Now a single cable modem or DSL line and a centralized printer can service four users. This can save a small business hundreds of dollars a year.

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Limited Connectivity

For limited connectivity, computer stores are stocked with wireless vendor products that are cost effective, easy to install, and very robust that will push even the most cautious computer user to take the leap to wireless computing. Not only does it make the initial cost to install a network cheaper than it has ever been before, it eliminates the cost to remodel or move computers within a building since instead of requiring data wiring at each proposed desktop all you need now is an electrical outlet to power the PC itself.

Satellite

This is a more modern device. In the past, satellite connections were at 400K bps or fourteen times faster than the average modem. As an example, a 2MB file would be downloaded in 30-40 seconds. Benefits of the satellite connection are: The connection is always on; it is reliable; there is a secure connection; office can have multiple e-mail addresses; the web space is free; and there is tech support coverage nationwide. Costs include around $300 for the equipment, $150 plus to install the equipment, and around $30 to $50 per month for service. Web site reference is satcast.com (DirecWay Satellite Dish).

Conclusion

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Understanding Automobile Insurance

Posted on May 7, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A Review for Physicians

By Gary A Cook; MSFS, CLU, ChFC, RHU, CFP® CMP™ (Hon)

Like the Home Owners policy, automobile insurance comes in a package (commonly called a Personal Auto Policy, or PAP) containing declarations, forms and endorsements.

These are: Liability Coverage, Medical Payments coverage, Uninsured Motorist coverage, and Coverage for Damage to your auto.

Important Elements

The important elements of automobile coverage are:

The vehicle or vehicles is covered, whether owned or leased
The insured – the covered driver
What is covered?
What are the limits of coverage – for both property and liability?

Exclusions

What are the exclusions – for example, the business use of a vehicle may not be covered under the personal policy? Other coverage for example includes a friend driving your car, or, coverage driving a rental vehicle. The medical payments coverage outlines the limits of liability for medical services needed as the result of an accident.

PULP

The final area of common personal coverages is the Personal Umbrella Liability Policy. To say that our society has become very litigious may be a gross understatement. The umbrella liability policy transfers the risk of losing substantial assets or future personal income to pay legal obligations resulting from an adverse judgment. The umbrella policy originated to provide risk protection against catastrophic legal claims or judgments. Typically, coverage limits begin at $1 million with upper limits of $10 million, and some unique situations, more. The term “umbrella” arises from the contract language that reflects that the individual carries the appropriate underlying basic coverages (homeowners or automobile) and that this coverage is triggered after the limits of the base contracts are exhausted.

Provided Coverage

An important element of this policy is that coverage provides for protection for the named insured, spouse, and family members living in the household. This coverage should be very important to those households with teenage drivers. Organizations may also obtain the protection of an umbrella policy, with certain limitations and exclusions. Unfortunately, “failure to render proper professional services” is very frequently a common exclusion, though some insurance companies will cover this loss exposure with an increased premium.

Other Policies

Other common policies available include: Watercraft and Airplane coverage, Title Insurance, Flood Insurance (offered by very few private insurance companies), Renters Insurance (which covers the contents), and Condominium protection (like homeowners, but has language for common wall risks).

Personal Legal Expense Protection

Finally, there is the issue of the taxation of premiums and claim payments. Premiums for personal property and casualty coverage are not deductible. Therefore, only under unusual circumstances will any benefits received from the coverage be considered taxable income.

Assessment

However, the benefit payments may be considered capital gain if they happen to exceed the insured’s basis in the property. Uninsured losses are generally deductible under the current Internal Revenue Code.

As usual, specific questions concerning the taxation of premiums or benefits should be directed to your professional advisors.

Conclusion

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Application Service Provider Primer for Physicians

Posted on May 7, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding ASPs

By Carol S. Miller; RN, MBA

An Application Service Provider (ASP) enables healthcare organizations to run complex software programs or applications on remote servers that can be accessed from numerous sites and by numerous devices. By installing and maintaining central, instead of on-site services, ASPs reduce the complexity, time, resources, hardware requirements, technical support, cost of installing and distributing upgraded software (done by ASP at its host site), and cost involved in application management. In addition, ASPs provide the physician a means of low cost entry to new applications in a very short timeframe. Upgrades are quickly deployed and healthcare organizations or medical offices can experience affordable and secure business critical applications. Most ASP services are billed on a per use basis or monthly annual fee. An example of an ASP is NextGen, an Internet based enterprise and a real-time practice management system that includes an electronic medical record, appointment scheduling, connectivity with hand-held solutions and patient indexes.

Reverse ASPs in Healthcare

Healthblocks (www.healthblocks.com) coined the term “reverse ASP” to signify that as an ASP, it provides unique solutions through the Healthblocks eSite, tailored to the situations and circumstances that face healthcare organizations and care givers on a daily basis. More formally, a reverse ASP deploys through portals, hosts and manages access to medical applications that offices, in a single, seamless manner, can view a patient’s clinical information. The applications are delivered over networks on a subscription basis and the reverse ASP remotely manages the packaged application over a network. The following benefits are achieved in this model:

Hardware/software located on recipient’s facility can connect disparate facilities
User names/passwords are located on-site with extensive integration with legacy systems
Existing clinical data remains on-site without danger of lost data
Connectivity to ASP solutions is not dependent upon an ISP

Assessment

A reverse ASP model provides physicians, nurses, allied healthcare providers and related personnel with rapid access to confidential clinical patient information. It can also benefit and help extend the reach and usefulness of third-party e-health solutions in a cost-effective manner.

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Conclusion

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Physician Property, Casualty and Liability Protection

Posted on May 6, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Essentials of Risk Management

By Gary A Cook; MSFS, CLU, ChFC, RHU, CFP® CMP™ (Hon)

Medical professionals may not be familiar with the unique differences between the terms – property, casualty and liability. Property insurance is coverage for the loss of, or damage to, real and personal property caused by fire, theft, explosion, riot, vandalism and a host of other risks. Casualty and liability are generally interchangeable terms for the coverage of legal liability due to injury to others or damage to their property.

Personal Liability Coverage

One of the most common of all personal liability coverages is the Homeowner’s policy. This is not one policy, but several policy declarations (what is insured – the location), forms, endorsements, and “floaters,” which protect the structure of the home against loss, as well as the personal property (contents) to various degrees. Risks for homeowners need not be consistent across the country and the rates generally reflect the differences. For example, homes in the Midwest need protection from tornados, while homes along the East, West and Southern coasts need coverage for hurricanes and flood risks.

Policy Form

The Home Owners Policy Form contains five categories of coverage for property:

The dwelling
Other structures
Personal property
Loss of use
Additional coverages, such as debris removal, trees, shrubs, and plants, or now, electronic theft (credit card, checking account theft).

The Contract

The contract contains three areas of Liability Coverage:

Personal liability
Medical payments to others
Miscellaneous liability benefits.

The Endorsements

Endorsements are an important aspect of the Homeowners coverage because they permit the customization of the coverage to the unique requirements of the individual. Two examples:

We noted that the West coast does not have tornados, however, they do have earthquakes and therefore, an endorsement can be added which will transfer the risk for earthquakes – or even volcanic eruptions. If the individual doctor has a home business, the business property can be protected against such perils as loss of business records due to fire or water damage. There is, however, no coverage for liability for providing poor professional services.

The Floaters

Finally, the Homeowners policy may contain “floaters” (named because the articles covered are moveable, thus “float around.”). The use of floaters can be very beneficial for coverage of unique or expensive electronic equipment and most commonly, jewelry. The other common personal coverage is Automobile Insurance. Forty-two states have compulsory insurance laws that require insurance on automobiles before it is registered. Various states have unique laws pertaining to:

Financial Responsibility, or proof of responsibility, by carrying insurance, a cash deposit, bond or security for future liability effective after an accident, which is the major criticism of these laws.
Unsatisfied Judgment Funds that compensate individuals who are unable to collect from a judgment resulting from an automobile accident.
Uninsured Motorist Coverage is required in most states as mandated by state insurance regulators. In essence, the insured’s own insurance company acts as the insurance company for the uninsured motorist.
No-fault Automobile Insurance stems from the problems associated with today’s tort law. These policy forms, however, vary dramatically by state and a full discussion is not possible here. Information and advice from a professional insurance agent is always recommended.

Conclusion

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Long-Term Care Insurance

Posted on May 5, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A Review for Doctors and Advisors

By Gary A. Cook; MSFS, CLU, ChFC, LUTC, RHU, CFP®, CMP™ (Hon)

Long-term care (LTC) insurance is considered one of the newest forms of personal coverage insurance. LTC insurance is designed to transfer the financial risk associated with the inability to care for oneself because of a prolonged illness, disability, or the effects of old age. In particular, it is designed to insure against the financial cost of an extended stay in a nursing home, assisted living facility, Adult Day Care Center, hospice or home health care. It has been estimated that two out of every five Americans now over the age of 65 will spend time in a nursing home. As life expectancy increases, so does the potential need for LTC. One unfortunate consequence of being the “new kid on the block” is the lack of actuarial data specifically collected for this style of policy. This results in policy premiums being underpriced to sustain the claims currently being experienced. During the first half of 2003, at least three insurance companies stopped writing these policies because of their losses. Those insurers remaining in this market are expected to increase premiums quickly. Unless these policies can be profitable for the company, their future will be an uncertain one.

Medicare

Any discussion of LTC must begin with an understanding of what Medicare is designed to cover. Currently, the only nursing home care that Medicare covers is skilled nursing care and it must be provided in a Medicare-certified skilled nursing facility. Custodial care is not covered. Most LTC policies have been designed with these types of coverage, or the lack thereof, in mind. To qualify for Medicare Skilled Nursing Care, an individual must meet the following conditions:

Be hospitalized for at least three days within the 30 days preceding the nursing home admission;
Be admitted for the same medical condition which required the hospitalization; and
The skilled nursing home care must be deemed rehabilitative.

Once these requirements are met, Medicare will pay 100 percent of the costs for the first 20 days. Medicare covers days 21 to 100 along with a daily co-payment, which is indexed annually. After the initial 100 days, there is no additional Medicare coverage. Medicare Home Health Services cover part-time or intermittent skilled nursing care, physical therapy, medical supplies and some rehabilitative equipment. These are generally paid for in full and do not require a hospital stay prior to home health service coverage.

Critical LTC Policy Features

According to the U.S. Department of Health and Human Services and the Health Insurance Association of America, there are seven features that should always be included in a good long LTC policy:

Guaranteed renewable (as long as premiums are paid, the policy cannot be canceled).
Covers all levels of nursing care (skilled, intermediate and custodial care).
Premiums remain level (individual premiums cannot be raised due to health or age, but can be raised only if all other LTC policies as a group are increased).
Benefits never reduced.
Offers inflation protection.
Full coverage for Alzheimer’s Disease (earlier contracts tried to eliminate this coverage).
Waiver of premium (during a claim period, further premium payments will not be required).

In addition, there are another seven features considered to be worthwhile and are included in the better LTC policies:

Home health care benefits
Adult day care and hospice care
Assisted living facility care
No prior hospital stay required
Optional elimination periods
Premium discounts when both spouses are covered
Medicare approval not a prerequisite for coverage.

ADLs

Most LTC policies provide benefits for covered insured’s with a cognitive impairment or the inability to perform a specified number of Activities of Daily Living (ADLs). These ADLs generally include those listed below and the inability to perform two of six is generally sufficient to file a claim:

1. Bathing: Washing oneself in either a tub or shower, or by sponge bath, and includes the task the getting into and out of the tub or shower without hands-on assistance of another person.

2. Dressing: Putting on or taking off all necessary and appropriate items of clothing and/or any necessary braces or artificial limbs without hands-on assistance of another person.

3. Toileting: Getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene without hands-on assistance of another person.

4. Transferring: Moving in and out of a bed, chair or wheelchair without hands-on assistance of another person.

5. Eating: The ability to get nourishment into the body without hands-on assistance of another person once it has been prepared and made available.

6. Continence: The ability to voluntarily maintain control of bowel and/or bladder function, or in the event of incontinence, the ability to maintain a reasonable level of personal hygiene without hands-on assistance of another person.

Other Issues

Another issue concerning ADLs is whether the covered insured requires “hands-on” assistance or merely needs someone to “stand-by” in the event of difficulty. Obviously, LTC policies that read the latter are considered more liberal.

Long-Term Care Taxation

Some LTC policies have been designed to meet the required provisions of the Kassenbaum-Kennedy health reform bill, passed in 1996, and subsequently are “Tax Qualified Policies”. Insured’s who own policies meeting the requirements are permitted to tax deduct some of the policy’s premium, based on age, income and the amount of total itemized medical expenses. The major benefit of the tax-qualified LTC policy is that the benefit, when received, is not considered taxable income. There are several initiatives in Congress, however, which would expand and simplify these deductibility rules.

Assessment

Regardless, the medical professional or financial advisor [FA] should investigate the opportunity afforded them through their current form of business, or client use, for any purchase of a LTC policy. And, small businesses may be permitted to deduct LTC premiums on a discriminatory basis.

Conclusion

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ISP Primer for Physicians

Posted on May 5, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Basic Access and Connectivity

By Carol S. Miller; RN, MBA

To connect with an Internet service, the medical office will need a computer, modem, telephone line and software. The modem, either external via a connection or internal via a built-in or slot card, takes the digital signals from your computer and converts them to analog signals that your phone line uses. As a rule of thumb, the faster the better; therefore, the office should have at least a 56 bps or use a DSL line.

Accessing the Internet

To access the Internet, the office must obtain an Internet Service Provider (ISP) such as America Online (AOL), Earthlink, ATT Worldnet, Microsoft Network Premiere (MSN), Hot Link, or others. The cost varies on the plan selected but usually averages in the range of $10 to $25 per month. In selecting an ISP, several guidelines need to be considered:

The major online services often make it very easy to connect to the Internet, but may be more expensive;
Many low-priced ISPs may have customer service that matches their prices;
In selecting the ISP, make sure the provider has a toll-free or local support telephone line;
For a nationwide directory list of ISP providers, go to the Internet site of www.isp.com.

Besides the POTS (plain old telephone service), the physician may wish to have a faster connection to the Internet. Several options are available.

Cable Modems

Cable connection is very fast, providing a lot of bandwidth (the amount of information that can be sent through a particular communication channel). As an example, in the time it takes to transfer a half page across a 56K connection, the cable connection can transfer over 25 pages. As is suggested by the name, the local cable TV provider or community antennae TV (CATV) deliver this service.

www.HealthDictionarySeries.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? Who can update the above for modernity?

Link: https://healthcarefinancials.wordpress.com/2009/03/13/rip-retail-financial-services-industry/

Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Healthcare Organizations: www.HealthcareFinancials.com

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Filed under: Book Reviews, Career Development, Glossary Terms, Information Technology, Practice Management, Sponsors | Tagged: AOL, bandwidth, cable modems, carol s. miller, CATV, david marcinko, DSL, EHRs, EMRs, hope hetico, internet connectivity, ISPs, MSN, POTS | 1 Comment »

Essential Insights on Successful Physician Budgeting

Posted on May 4, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Avoiding Common Cash Flow Budget Mistakes

[By Dr. David Edward Marcinko; MBA, CMP™]

[By Hope Rachel Hetico; RN, MHA, CMP™]

[Publisher-in-Chief and Managing Editor]

Although some doctors might view a budget as unnecessarily restrictive, sticking to a spending plan can be a useful tool in enhancing the wealth of a practice. We emphasize the keys to smart budgeting and how to track spending and savings in these tough economic times.

Money and Happiness

There is an aphorism that suggests, “Money cannot buy happiness.” Well, this may be true enough but there is also a corollary that states, “Having a little sure reduces the unhappiness.” Unfortunately, today there is more than a little financial unhappiness in all medical specialties; not just the specialty of podiatry – where this article first appeared as a free-lance writing project. The challenges range from the commoditization of medicine, aging demographics, Medicare reimbursement cutbacks and increased competition to floundering equity markets, the home mortgage crisis, the squeeze on credit and declines in the value of a practice. Few doctors seem immune to this “perfect storm” of economic woes.

Most Doctors Financially Hurting Today

Far too many physicians, dentists and other medical providers are hurting and it is not limited to these above-average earning professionals. However, one can strive to reduce the pain by following some basic budgeting principles. By adhering to these principles, most physicians can eliminate the “too many days at the end of the month” syndrome and instead develop a foundation for building real wealth and security, even in difficult economic climates like we face today.

Three Budget Types

There are at least three major budget types. [1] A flexible budget is an expenditure cap that adjusts for changes in the volume of expense items. [2] A fixed budget does not. [3] Advancing to the next level of rigor, a zero-based budget starts with essential expenses and adds items until the money is gone. Regardless of type, budgets can be extremely effective if one uses them at home or the office in order to spot money troubles before they develop.

Assessment

For the purpose of wealth building, medical professionals may think of a budget as a quantitative expression of an action plan. It is an integral part of the overall cost-control process for the individual, his or her family unit or one’s medical practice.

Read the entire article: http://www.podiatrytoday.com/essential-insights-on-successful-budgeting

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Conclusion

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ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: "Doctors Only", Accounting, Career Development, Financial Planning, iMBA, Inc., Practice Management, Research & Development | Tagged: budgeting, cash flow, cash flow crunch, david marcinko, fixed budget, flexible budget, hope hetico, podiatry today | 2 Comments »

Selecting an Assisted-Living Facility

Posted on May 4, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Checklist for Financial Planners

[By Staff Reporters]

Thousands of boarding homes cater to the elderly. Their operators promise to provide at least a place to sleep and food to eat. Beyond that, the services and assistance offered will vary from facility to facility. This checklist will help the financial planner or his or her client find a facility that is appropriate in all respects to the client’s resources and needs. Unlike nursing homes, assisted-living facilities often operate without any scrutiny from public agencies. Furthermore, Medicaid often will not be a source of funds.

The Checklist

The items the financial planner and client should consider when selecting a facility are listed below.

1. Determine the client’s willingness to live in a group environment.

2. Avoid unlicensed facilities, particularly if Medicaid-provided services may be needed in the future.

3. Review the facility’s inspection report.

4. Review the facility’s service contract and house rules. Look for answers to the following questions:

a. Where will the resident live?

Are there any types of ownership rights?

What flexibility is there with respect to furnishings?

Will the same unit be available after a hospital stay?

b. What meals are included?

Will the facility provide appropriate meals and a special diet?

c. What form of transportation does the resident currently use?

What transportation is provided by the facility?

Can residents shop, dine, attend services or visit doctors?

d. What help does the facility provide during a medical emergency?

What type of staff training is provided or required? Is there 24- hour-a-day staffing?

e. What provisions are there for privacy? When are rooms cleaned and when can staff access the rooms?

f. What is the basic cost and what are the costs for extras?

What is included in each?

What provisions for fee increases are there?

g. Can a resident see his or her own doctor?

Does the facility offer transportation for appointments?

h. Who’s in charge of administering and scheduling medication?

Can medication and other supplies be purchased at the facility?

i. What happens if the resident’s health begins to fail?

Does the facility provide additional services to help with ADLs?

j. What is the procedure for transfers from one unit to another?

Does the resident have any opportunity to express an opinion?

k. What’s required if a contract is terminated by facility or resident?

What is the provision with respect to refunded fees?

Is there a required minimum stay?

Assessment

What have we missed?

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Book Reviews, Estate Planning, Ethics, Financial Planning, Health Law & Policy, Insurance Matters, Quality Initiatives, Recommended Books, Retirement and Benefits, Sponsors | Tagged: assisted living, david marcinko, elder care, elder law, eldercare, extended care facilities, financial planners, hope hetico, insurance, long term care, long term care insurance, LTCI, Medicaid, medicare, nursing homes, senior advisors, senior care, senior case managers | 3 Comments »

Advisor’s Checklist for Physicians Seeking Insurance

Posted on May 3, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Background, Education, and Certifications

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chief

The following are sample questions and information gathered for Professional Liability Coverage

The Checklist

**Medical specialty information by percentage of practice.

**Information on medical education, including information on medical school, internship information, residency information, and fellowship information, if any.

**Information on medical experience, including information on military discharge (DD214), public health service, moonlighting, ‘locum tenens’, and private practice information. Have dates and locations available. Other information includes:

Information on completed continuing education hours in the past two years.
Publications, speeches, instruction, etc.
Information on medical licenses, including state, license number, expiration dates, and current status.
Information on board certifications.
The above information may be contained in a Curriculum Vita, if you have one.
On an “as applicable” basis:
Complete details including dates and outcomes of any board certification revocations or suspensions, license revocations or suspensions, alcohol or drug addictions and treatments, criminal or sexual misconduct charges, or Medicare or Medicaid charges.
Previous Insurance Information
Insurance history, including the name, policy number, whether the coverage form was occurrence or claims made, policy period, limits of liability, deductible amount, and prior acts date, for your current carrier, and your first, second, third, and fourth prior carrier, if applicable.
Information on any insurance company cancellations or non-renewals.
If your current policy is a claims-made policy, whether you are obtaining tail coverage from your current insurance company.
Copies of prior policies, if available.

Current Medical Practice Information

Information on supervision and employment of residents, physician assistants, nurse practitioners, CRNAs, nurse midwives and other physicians;
Information on networks or managed care organizations associated with (IPA, PHO, MSO, etc.), including group name, type of organization, and relationship;
Information on other contractual relationships other than PPOs, HMOs, IPA, etc;
Full information on all hospital privileges, including hospital name, location, and type of privilege.
Information on any suspension, denial, revocation, restriction, or other sanctioning of hospital privileges.

Classification and Specialty Identification

Full information on procedures performed, including details of surgeries, average number of patients seen weekly, specialty practice areas, etc.

Prior Claims History (if any)

For each claim, patient’s name; date of occurrence; insurance carrier; location of occurrence; date claim was reported; date claim was closed (if applicable); copies of subpoenas, pleadings, or judgments; amount reserved on your behalf; and amount paid on your behalf. Provide as complete a description of the allegations as possible.

Important Note

This checklist is provided as a guide to assist the Healthcare Professional in gathering the information that insurance companies typically request. Discuss this checklist with your agent to identify additional information as needed.

Assessment

The author has been an expert medical witness in both state and federal court. He is also a former licensed insurance agent and certified financial planner.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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Reviewing Medical PDAs

Posted on May 3, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Physician Use Growing Slowly

By Carol S. Miller; RN, MBA

Handheld personal digital assistants (PDAs), such as Palm Pilot M130, 500 or 515, Sony Clie, Visor Prism or Pro, Psion, RIM Blackberry, Zaurus, iPhone, Zune and other comparable PDA OS platforms, have revolutionized the communication world this past decade. PDAs and their future counterparts are becoming the catalyst for physicians to use information technology, are becoming the intro for physicians into the world of the electronic medical record software, and becoming the virtual office tool, enabling providers to communicate away from the desktop as well as away from his office practice. The reasons for increased utilization with physicians are portability, pocket-size, provides easy access to information at point of care and regardless of location, improves practice efficiency and workflow, improves drug related decisions and decreases adverse drug events.

PDA Components

The common uses of PDAs by physician practices are:

Personal applications such as scheduling, telephone directories, dictionary, “to-do lists” and others
Drug databases
Clinic suite that ties into the hospital information system
Charge and procedure capture
Communications, from provider to provider, provider to hospital, provider to office, and vice versa

Palm Operating System

Palm OS still represents the standard in handheld computing, assisting individuals to manage and access information at any time, at any location. Handhelds are easy to use. Physicians are using the Palm OS and/or compatible PDAs to access their office schedules, receive downloads of clinical information on their patients, and enter clinical services and charges when performing services at remote locations.

PDA Selection

In selecting not only the PDA but also the software, the physician needs to answer the following questions:

What would you like to use the PDA for – clinical reference data, patient information, non-clinical applications, personal data, etc.?
What information do you need to know about the patient that the PDA can simplify?
What is the connection route between the hospital, managed care, or lab and your practice? In other words, how do you get access to the data?
What are your price considerations?
Do you need a color or black and white screen?
What is the system support and warranty?
How do you plan to connect to the office or hospital?
Do you want to go wireless or obtain information via a telephone connection?
Do you plan to render care outside of your office practice, such as in the home, a clinic, hospital setting, etc? If so, what would you like included on the PDA that would improve communication with the office and save time at point-of-service in documentation?

HIPAA

HIPAA regulations do not specifically address the specific term PDA, but the regulations do include guidelines for protecting patient information and transmission of this data that can impact the use of PDAs. Physicians are utilizing handheld digital assistants whether they contain clinical information; or just resource data, may be or not are password protected, and may or may not be officially supported by hospitals or clinics. Providers as they prepare for future applications and usage of PDAs involving patient information must understand the scope of the new HIPAA regulations as it impacts on patient data collected, stored or transmitted. Any application involving patient identifiable data must be HIPAA compliant. The key issues are how to protect the patient information stored on the device, i.e., if lost or stolen, and second how to protect patient information transmitted during a synchronization or wireless transaction. Probably the most vulnerable aspect is the loss rate with recent studies indicating at least 30%.

Security

Most providers using PDAs for patient data utilize a user ID or password level of security. To maintain security, the provider should be required to re-enter their user ID or password every time they enter the application. Likewise, each PDA should have a “time out” feature, requiring a provider to re-enter his ID or password again. This feature will not prevent individuals with technical skills from accessing this information – the only mechanism is encryption.

Synchronization versus Wireless Applications

1. Synchronization transfers information from the enterprise database to the PDA, i.e., hospital lab or x-ray results, patient demographics, consultative notes, and others. It is important that the hospital or hospital system authorize and approve the physician for using and transmitting this information and in turn, the provider authenticates and validates his agreement with the hospital before data is transmitted. In addition for protection, an audit trail of who synchronized and what data was transmitted should be maintained by the hospital system.

2. Wireless providers have immediate real time access to patient data; however this process of transmission is more vulnerable than synchronization. Wireless solutions can utilize a public or private network. HIPAA require encryption for the transmission of data over the public networks – Encryption is optional for others. Sharing data from a wireless over the Internet represents potential security issues; however, more and more technical firms and providers are using a wireless VPN that allows PDA users to connect securely from remote locations just as laptop users do today.

Other Issues

The other issues are who owns the PDA. If the provider does, he or she should be responsible for the security; however if the hospital does, the hospital should be responsible. More current applications of Palm OS will include built-in modems for easier wireless communication, improved secure transactions, and ability of greater resolution for graphics, and other Web-based services. In addition, current and future applications will include refined voice dictation. As an example, MDEverywhere’s package called Everynote allows the provider to digitally record notes and in turn links with MDEverywhere’s coded patient encounter.

The Blackberry

A very versatile product is the Blackberry. It has web browsing capabilities, embedded wireless modem and can (1) write, send receive and respond to messages right from the unit, (2) access web information, (3) has nationwide coverage with no roaming fees, (4) has voice mail message capabilities, and (5) can be the size of a pager or PDA. The next feature with Blackberry will be its text messages to cell telephones. New units start around $150-$300 with monthly service charges of $20-$50 depending on the plan. The wireless Internet connection can be accomplished through Go.Web.

Assessment

The typical cost for a PDA averages between $300 and $600 – depending on color or black and white – plus the cost of additional software and accessories. For wireless connectivity, the physician will need to connect with a communication partner. Reference sites for PDAs are: www.handheldmed.com (for clinical, reviews, and news), www.pdamd.com (PDA resources), www.freewarepalm.com (free software programs), www.palmpilot.com, www.handspring.com. The active shopper can refer to www.zdnet.com or www.palmblvd.com

Conclusion

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Filed under: Book Reviews, Career Development, Health Law & Policy, iMBA, Inc., Information Technology, Practice Management, Sponsors | Tagged: apple iphone, blackberry, carol s. miller, david marcinko, EHRs, EMRs, handheldmed.com, handspring.com, Health I.T., HIPAA, hope hetico, iPhone, MDE, OS, Palm, Palm OS, PDA, personal digital assistants, telemedicine, Zune | Leave a comment »

Red Flag Rules in Dentistry

Posted on May 1, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Mayday for Identity Theft Provisions 2009

By Darrell K. Pruitt; DDS

On October 22, 2008, the FTC announced that it would delay the enforcement of the Red Flags Rule for healthcare providers for six months – until May 1, 2009. A handful of attentive dentists, as well as ADA Chief Legal Counsel, Tamara Kempf, released a sigh of relief. Ms. Kempf immediately went to work to persuade the FTC to delay enforcement “indefinitely.”

The FTC Delay

Four days later, Kempf caught the mood of the few who were paying attention in her quote for an article on DentalCompare.com:

“We are very pleased that the Federal Trade Commission has postponed for six months its implementation of the ‘Red Flags Rules.’”

http://www.dentalcompare.com/news.asp?newsid=250078

The DentalCompare article continues:

“If the FTC persists in its position that dentists are covered by the rule as creditors, the ADA will make available a sample compliance plan or program well in advance of the new enforcement date. Dentists will have sufficient time to consult with their personal attorneys and to put an appropriate identity theft prevention program into place, according to the ADA’s Legal Division.”

The ADA Legal Division

Did the ADA’s Legal Division follow through with its promise? If information about the Red Flags Rule is posted on the ADA News Online Website early tomorrow morning, is a 24 day warning considered by the ADA to be “well in advance”? (Emphasis mine) As reassuring as Kempf’s words sounded five months ago, it can be argued that the ADA’s intentions were misrepresented to DentalCompare. I checked the ADA Online Website and found nothing at all about preparation for the Red Flags Rule – at least not yet.

http://www.ada.org/prof/resources/pubs/adanews/index.asp

ADA Archives

When I searched the ADA archives for “Red Flags Rule,” I was provided seven links to the topic, but none included “a sample compliance plan or a program.” Three of the links are irrelevant, three are to articles about the delay of the FTC enforcement, and one is a link to a hopeful letter dated November 24, 2008 and addressed to William E. Kovacic, Chairman of the Federal Trade Commission. In other words, I found nothing that will help dentists become FTC compliant well ahead of time.

HIPAA

If the ADA’s help in preparing members for the 1996 HIPAA Rule is any indication of the help members can expect with Red Flags Rule, it will take the ADA at least 13 years to start on the Red Flags. The leaders of the otherwise conservative ADA seem to have bet a huge chunk of membership trust that Kempf and the Legal Affairs department would succeed in delaying Red Flags enforcement indefinitely, and that the Department of Dental Informatics would not have to admit that contrary to what they led members to believe, computers in dental offices are rapidly becoming too dangerous and too expensive for the profession. For many dentists, pegboards, carbon paper and ledger cards are looking better and better. You can forget about paperless practices. What happened, ADA?

The groveling November 24 letter to the FTC chairman that was signed by Kempf and cc’d to ADA President Dr. Johns S. Findley and President-elect Dr. Ronald L. Tankersley, officially begs for forgiveness and appeals for bureaucratic mercy to allow dentists to be excluded from becoming Red Flags-covered entities.

http://www.ada.org/prof/advocacy/let_081124_redflags.pdf

Since the fines for non-compliance of both HIPAA and the Red Flags Rule are obscene, and since the leaders of the ADA continue to fail to inform members what they should do to prepare for unannounced inspections from either HHS or the FTC, I will once again do the Department of Dental Informatics job for them, and let readers in on the secret.

An Economic Threat

If you wish to continue to accept assignment from insurance companies, and/or otherwise extend credit to your patients, the FTC recently posted a helpful pdf document titled “Fighting Fraud with the Red Flags Rule – A How to Guide for Business.”

http://www.ftc.gov/bcp/edu/pubs/business/idtheft/bus23.pdf

Dentists have become the nation’s unpaid fraud inspectors. And if a dentist’s practice is computerized, the more will be expected, or rather, demanded of the dentist, by law.

Here is a brief description of dentists’ Red Flags obligations lifted from the FTC document:

An Overview

The Red Flags Rule sets out how certain businesses and organizations must develop, implement, and administer their Identity Theft Prevention Programs. Your Program must include four basic elements, which together create a framework to address the threat of identity theft:

First: Your Program must include reasonable policies and procedures to identify the “red flags” of identity theft you may run across in the day-to-day operation of your business. Red flags are suspicious patterns or practices, or specific activities that indicate the possibility of identity theft. For example, if a customer has to provide some form of identification to open an account with your company, an ID that looks like it might be fake would be a “red flag” for your business.

Second: Your Program must be designed to detect the red flags you’ve identified. For example, if you’ve identified fake IDs as a red flag, you must have procedures in place to detect possible fake, forged, or altered identification.

Third: Your Program must spell out appropriate actions you’ll take when you detect red flags.

Fourth: Because identity theft is an ever-changing threat, you must address how you will re-evaluate your Program periodically to reflect new risks from this crime.

Note: More “red-flag” information may be obtained from the 2 volume, 1,200 pages, premium print guide: Healthcare Organizations [Financial Management Strategies].

www.HealthcareFinancials.com

Assessment

Since my business office still uses the pegboard, and no patients’ identifiers are on any computer, my official Red Flags policy is simple:

“Staff; if you notice anything unusual in relation to our patients’ accounts; or if you are handed an unusual-looking drivers license, notify me immediately”.

-The Management

My official notice will be fastened with thumb tacks to my wall of safety posters by May 1, 2008, and I will be in full compliance with not only HIPAA, but the Red Flags Rule as well. If the government continues its reckless, heavy-handed, one-size-fits-all laws, it won’t be long before I’ll be able to further undercut the fees charged by all computerized dental offices, and still make more profit. I say bring out the Department of Agriculture.

Conclusion

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Filed under: Alerts Sign-Up, Book Reviews, Breaking News, Career Development, Health Law & Policy, Healthcare Finance, iMBA, Inc., Information Technology, Managed Care, Practice Management, Professional Liability, Risk Management | Tagged: accounting ledger cards, ADA, AMA, American Dental Association, carbon paper, DDI, DentalCompare.com, Department of Dental Informatics, Dr. Ronald L. Tankersley, fake IDs, FTC, HIPAA, HSS, ID, identity theft prevention, Johns S. Findley, pegboards, red flag rules, Tamara Kempf, William E. Kovacic | 32 Comments »

Networks Basics for Medical Professionals

Posted on May 1, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Defining WANs and LANs

By Carol S. Miller; RN, MBA

Depending on whether the practice is housed in one or multiple-office locations and there is a need to connect multiple computers, either a local area network (LAN) or wide are network (WAN) should be part of the package consideration.

The LAN

The LAN is a computer network that covers only a small area (often a single office or building). The advantage of a LAN (besides connecting several computers to a network system) is the ability to configure one printer for multiple stations. The same may be said for sharing administrative, clinical, financial and operational data in real-time manner to support smooth office function.

The WAN

The WAN provides the ability to link data on one network for multiple office site locations.

www.HealthDictionarySeries.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? Who can update this post for modernity?

Link: https://healthcarefinancials.wordpress.com/2009/03/13/rip-retail-financial-services-industry/

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Filed under: Book Reviews, Career Development, Glossary Terms, iMBA, Inc., Information Technology, Practice Management, Recommended Books, Sponsors | Tagged: carol s. miller, david marcinko, hope hetico, LANs, medical computer networks, WANs, www.healthdictionaryseries.com | Leave a comment »

Events-Planner: May 2009

Posted on May 1, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Events-Planner: MAY 2009

Staff Writers

“Keeping track of important health economics and financial industry meetings, conferences and summits”

Welcome to this issue of the Medical Executive-Post and our Events-Planner. It contains the latest information on conferences, news, and relevant resources in healthcare finance, economics, research and development, business management, pharmaceutical pricing, and physician/entity reimbursement! Watch for a new Events-Planner each month.

First, a little about us! The Executive-Post is still a newcomer. But today, we have almost 15,000 visitors and readers each month from all over the country, in addition to our growing subscriber base. We have been a successful collaborative effort, thanks to your contributions. As a result, we are adding new resources daily. And, we hope the website continues to provide the best place to go for journals, books, conferences, educational resources, tools, and other things you need to establish the value your healthcare consulting and financial advisory intervention. And so, enjoy the Executive-Post and our monthly Events-Planner with our compliments.

A Look Ahead this Month

May 1: Print Edition Healthcare Journalism: If you would like to “step-up-your-game” and be considered as a peer-reviewed contributor to the third print edition of: The Business of Medical Practice [Health 2.0 Profit Maximizing Techniques for Savvy Doctors]; contact Ann at: MarcinkoAdvisors@msn.com. There are several chapter topics still available. Now, the important dates:

May 3-5: Spring Professional Development Conference: IMCA, San Diego, CA.

May 3-6: NAAIM Uncommon Knowledge Conference, Denver, CO.

May 6-8: FINRA Annual Conference, Boston, MA.

May 8: North Central Regional Conference, Healthcare Compliance Association, Columbus, OH.

May 12: Executive Forum on Rewards to Improver Employee Health, Chicago, Illinois.

May 11-15: International Wealth-Tax Management Seminar: CFA Institute, Lucerne, Switzerland.

May 12-14: Advances in Asset Allocation: CFA Institute, New York, NY.

May 13: National Medicaid Conference, HCCA, LLC, Washington, DC.

May 18-21: Leveraged Credit and Distressed Debt: CFA Institute, Charlottesville, VA.

May 19: Medicaid Rebates Conference, Lake Buena Vista, Fla.

May 19-22: TD Ameritrade Conference and Elite Advisor Summit, Atlanta, GA.

May 27-29: Morningstar Investment Conference, Chicago, Illinois.

Please send in your meetings and dates for listing in the next issue of our Events-Planner.

MarcinkoAdvisors@msn.com

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MSFT Amalga Video for Hospitals and Health Systems

Posted on April 30, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

It Was One Year Ago Today … Updated for 2009

By Staff Reporters

Release of a new unified intelligence system allows enterprise health providers to unlock the power of all data from their existing IT systems.

REDMOND, Wash. — April 9, 2008

Microsoft Corp. today announced the availability of Microsoft Amalga, the new unified intelligence system that allows hospital enterprises to unlock the power of all their data sitting in isolated clinical, financial and administrative solutions.

What it is – How it works

Amalga is part of the Microsoft Amalga Family of Health Enterprise Systems, a portfolio of enterprise-class health solutions that provides rich integration, giving clinicians and executive’s quick access to valuable, up-to-the-minute information across their health enterprise. Microsoft also announced the availability of the Amalga family of health enterprise products across Europe at conhIT 2008, a healthcare IT conference being held in Berlin this week (http://www.microsoft.com/emea/presscentre).

Health Vault

The patient compliment to Amalga is MSFT’s Health Vault initiative which helps consumers collect, store, and share critical patient health information, for free.

www.HealthVault.com

Assessment 2009

Video interview, by Matthew Holt, originally appeared on The Health Care Blog [THCB] on April 16th, 2009.

Link: http://www.thehealthcareblog.com/the_health_care_blog/2009/04/interview-microsoft-health-solutions-.html#comments

Conclusion

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Filed under: Career Development, Information Technology, Managed Care, Practice Management, Research & Development, Videos | Tagged: amalga, Chris Sullivan, conhIT, EHRs, EMRs, ePHs, health information technology, healthvault, Heath Enterprise Systems, IT, microsoft, MS-HUG, Randy Fusco, SUNSHINE, unified intelligence system | 2 Comments »

How to Select a Nursing Home

Posted on April 29, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Checklist for Financial Planners

[By Staff Reporters]

The following will enable the financial planner to assist the client in choosing a nursing home.

The Checklist

1. Review the client’s requirements. An assisted-living facility may suffice instead of a true nursing home, which is required by the frail and elderly needing daily medical care.

2. Pick a location close to home and relatives. Frequent visits are crucial, not only to combat loneliness but also to ensure resident receives proper attention.

3. Read inspection report (state survey). If the financial planner encounters difficulties in obtaining a current report, he or she should assume that the home has something to hide. Don’t expect perfection. Nursing homes provide a difficult service for difficult residents. If a home is unresponsive to inquiry regarding items in a report, assume a similar response to concerns about the quality of care being provided in the future.

4. Tour the facility on an unannounced basis at different times on different days. Stroll through corridors and look and listen. Trust senses and instincts. Items to consider should include:

· Appearance of residents’ rooms. Outward decor of facility can be misleading, so the planner should inspect the residents’ rooms. To what extent can the rooms be personalized? If rooms are shared, how are good roommate matches made?

· Smells. High-quality homes have no lingering stench of urine or air freshener to cover up bad care and unusually high incidences of incontinence due to lack of attention by staff.

· Safety hazards. Be especially aware of items in corridors that can be obstacles to those with unsteady gait and poor eyesight.

· Sufficient staff members who are pleasant and respectful to residents. Are staff members responsive to residents’ needs? Are staff members warm in their interactions with all residents, even those requiring the heaviest supervision? Are aides helping residents with walking or exercise of their arms and legs?

· Residents’ attitudes toward facility’s service. Talk with residents and staff to determine attitudes toward the facility’s service. Does the facility have a family counsel to provide it with input?

· Grooming. A clear sign of neglect is failure to keep residents clean, well dressed, and well groomed.

· Physical restraints. Nursing homes that have eliminated restraints also have improved quality of life and more social contact among residents. Ties, belts, vests, and high bed rails are an easy but unsatisfactory solution to managing residents. Count number of residents that are restrained; ask what percentage are restrained and why.

· Food. Visit at meal time and sample the food to make sure it is palatable. The setting for meals should be attractive and pleasant, and food should be served at the proper temperature. Staff should be available to help residents who are not able to feed themselves. Review menus and determine the amount of concern for nutrition.

· Activities. A wide variety of activities should be provided, and the participation level should be high. Bored residents in front of a television may be a sign of a home’s failure to stimulate its residents.

· Dignity. Residents should be handled in ways that respect their dignity. For example, are residents properly clothed in public?

· Bed sores. Bed sores are a sign of poor care. Review inspection reports and see if they are mentioned, or talk to residents or their families about this topic.

· Special care units. Such units are often used as an expensive marketing device. The special care units may not be designed well and may indicate a lack of outdoor facilities.

5. Review the facility’s policy on medical care. Will residents be seen by their personal doctors or by staff physicians? Does the home have good infection control and immunization plans? What sort of access to dentists and eye doctors is there?

6. Perform financial analysis. The planner should gain a complete understanding of what the client’s and/or his or her family’s financial commitments are and how they will be met.

· Determine the financial strength of the nursing home, particularly if client funds are to be advanced.

· Consider a single lifetime payment in lieu of monthly rental payments.

· Consider exclusions in contract. For example, nursing home insurance coverage should include loss of personal property and personal injury.

· Determine what services the client will require, what is covered under the facility’s general fee, and what services are provided for an extra fee. Determine what the extra fee will be for each additional service that will be required. Family members should not agree to pay these charges because this could delay Medicaid funding.

· Analyze pricing structure in general and what the pattern of increases in fees has been.

· Determine residents’ rights in eviction proceedings for nonpayment of rent, in returning to nursing home after hospital stay, and in having Medicaid make payments on behalf of resident.

· Determine residents’ rights to appeal decisions and what the appeal procedures are.

7. Obtain and check references, including families of current residents, local hospitals, doctors, and government agencies, particularly the ombudsman at state departments for aging.

Assessment

What have we missed?

Conclusion

In any case, early planning is the key to supporting both your kids’ futures and your retirement. Making logical college funding decisions, rather than emotional ones, creates a win/win for everyone.

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Filed under: Estate Planning, Financial Planning, Glossary Terms, Insurance Matters, Recommended Books, Retirement and Benefits | Tagged: david marcinko, extended care facilities, financial planner, hope hetico, insurance, nursing homes, senior care, senior care planner | 12 Comments »

On Baseline Medical Practice Compliance Audits

Posted on April 28, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Establishing a Reference Point is Key to Success

Submitted by Pati Trites; MPA, CHBC with Staff Reporters

www.HealthcareFinancials.com

There are several types of compliance audits that a medical practice, clinic or healthcare organization might need to perform. The starting point is to obtain a baseline audit. The next step, discussed elsewhere on this ME-P, is periodic audits or reviews that are performed after information is obtained from the baseline audit.

Baseline Audits

Baseline audits are preliminary assessments to develop a reference point. Until a medical practice or healthcare organization establishes a track record with items such as coding accuracy or documentation to support medical necessity, it is difficult to determine any performance issues. In the spirit of Total Quality Management [TQM], the information that is shared should be done in a non-punitive manner to demonstrate that the intent of the process is to create a positive environment geared towards fixing the problems. A baseline audit can help any organization understand where the program is and establish a reference for future activities.

Assessment

Additional audits can also be performed whenever new employees are added, or if there are complaints, or issues that arise in the course of business.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? Have you ever discovered an untoward past event, or interesting prior fact, with your baseline audit?

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Filed under: "Doctors Only", Health Law & Policy, Managed Care, Practice Management | Tagged: base line audits, compliance audits, david marcinko, hope hetico, medical compliance, medical necessity, Medicare audits, Medicare compliance, Pati Trites, quality medical management, TQM, www.healthcarefinancials.com | 1 Comment »

Defining and Understanding “Boutique Medicine”

Posted on April 28, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

What it is – How it Works

By Dr. David Edward Marcinko MBA

http://www.CertifiedMedicalPlanner.org

According to colleague Robert James Cimasi of Health Capital Consultants LLC in St. Louis MO, concierge or boutique medical practices began in the mid-1970s, and are now in many major metropolitan areas. Concierge medicine is described as a “return to old-fashioned medicine,” where physicians limit their client base and devote more time to each patient. Patients can usually get in to see their physician within a day, and most have 24-hour access to their physician by beeper or cell phone.

The Doctor’s Perspective

Physicians who turn to concierge medicine are typically tired of not having enough time with their patients and dealing with overbooked caseloads, and are looking for a way of balancing their lives while still providing quality care for their patients. Patients who have physicians in this type of practice appreciate the “perks” they get for paying a yearly fee — similar to “annual membership dues.” These fees can range anywhere from $1,000 per year to $10,000 per year depending on the patient’s age, benefits received, area of the country, and practice.

Patient Amenities

Amenities vary by practice, but some include longer physician office visits, increased access to physicians, e-mailed “newsletters” or condition-specific information, physicians accompanying patients on visits to specialists, and house calls. In order to provide more attentive care and amenities to patients, physicians often decrease their patient load to approximately 10-25% of their managed care load. Thus, most of their patients must find other physicians, leading to potential increases in the patient load of managed care physicians.

Elitist Patients

Although concierge medicine may provide many benefits for patients (including more, and in some cases, nearly unlimited access to their physicians), it has been met with some scrutiny. Some say that this type of medicine is elitist, that it is available only to wealthy patients who can pay the annual fees. Medicare beneficiaries who are members of a concierge practice have received political attention, because many politicians have said that the annual fees patients pay is a lot more than the Medicare rate and thus is illegal billing.

Critics

Critics also emphasize that healthcare needs to be first-rate for everyone, something that the current managed care system prevents. The implication that managed care means second-class medicine has also been a fear cited by critics.

Assessment

However, concierge physicians portray their clients as mostly middle-income people who are willing to pay more for this kind of care. Concierge medicine is not a substitute for health insurance. Patients typically keep their traditional insurance to pay for any tests or scans ordered by the physician.

MORE: https://medicalexecutivepost.com/2009/10/26/customer-relationship-management-and-the-nascent-concierge-medical-practice/

Conclusion

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Filed under: Career Development, Glossary Terms, Health Insurance, Managed Care, Quality Initiatives, Research & Development | Tagged: boutique medicine, concierge medicine, david marcinko, hope hetico, retainer medicine, robert james cimasi, www.healthcarefinancials.com, www.HealthDictionaySeries.com | 7 Comments »

Defining the Central Registration Depository

Posted on April 27, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Financial Terms and Economic Definitions

Staff Reporters

www.HealthDictionarySeries.com

FINRA operates Web CRD^®, the central licensing and registration system for the U.S. securities industry and its regulators. It contains the registration records of more than 7,500 registered broker-dealers and the qualifications, employment, and disclosure histories of more than 690,000 active registered individuals, making it the worlds’ largest and most sophisticated online registration and reporting system.

More Information

For questions or comments, medical professionals and all others may contact the FINRA Gateway Call Center at (301) 590-6500. Or, see the Dictionary of Health Economics and Finance.

Assessment

Now, to the extent that many believe that FINRA, the FPA, CFP BoS, and the SEC dropped the ball when it comes to financial advisor oversight and compliance, how important is the CRD anyway? Link: http://www.finra.org/Industry/Compliance/Registration/CRD/index.htm

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? Is the CRD still needed, or is it a plutocratic dinosaur?

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Filed under: Alerts Sign-Up, Career Development, Ethics, Financial Planning, Glossary Terms, iMBA, Inc., Investing | Tagged: broker-dealers, CFP BoS, CFPs, CRD, david marcinko, dictionary health economics and finance, financia advisors, FINRA, hope hetico, iMBA, Inc., RIAs, SEC, securities industry, Series 63, Series 65, Series 7, stock-brokers, www.healthdictionaryseries.com | Leave a comment »

Paradigm Shift to “Defined Health Contributions” from “Defined Health Benefits” Plans

Posted on April 27, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

What it is – How it Works

By Staff Reporters

In the past, according to Robert James Cimasi MHA AVA CMP™ of Health Capital Consultants LLC in St. Louis MO, many employers had defined retirement benefits for employees. Today, most retirement benefits are in the form of 401K plans where companies make defined contributions, effectively shifting the financial risk of paying for retirement to employees.

Defined Health Contributions

Defined health contributions are similar to employer-funded defined retirement contributions like 401K plans. Currently, employers pay for some portion of about half of Americans’ health insurance. Traditional employer-funded plans are those for which the employee simply fills out a form; that is, an employer will offer one or possibly two health insurance plans, and the employee fills out application paperwork. The employer administers the plan and may charge the employee a portion of the monthly premium or pay the entire premium themselves. A defined contribution plan allows companies to shift the financial risk of paying for rising health insurance costs.

Defined Health Benefits

Although part of the “benefit” of a health benefit plan is that the employer also takes care of all the administrative paperwork related to the insurance, companies are increasingly uninvolved in the administration process, opting instead to let the employee decide which plan out of many choices suits them best. For example, if an employer typically spends about $5,000 per employee per year on health benefits, the employer would use that money as a “defined contribution.” The employee then has $5,000 to spend per year on benefits, but instead of using the employer-defined health plan, the employee may choose from a variety of HMOs, preferred provider organizations PPOs, or other health plans. If the insurance premiums rise above this amount, the employee must make up the difference.

Defined Contribution Package

Many employers are currently offering a defined contribution package to their employees. The definition of “defined contributions,” however, can range from one in which employers are completely uninvolved in the administration of benefits and simply give their employees cash or vouchers for the amount contributed that they can use to buy coverage, to a more “defined choice model” where employers offer a variety of health options at differing price levels along with a premium dollar contribution, and a variety of other options in between.

Risk Shifting

Thus, defined contributions shift the financial risk from the employer to the employee. Defined care is not a replacement for managed care, but will probably cause managed care to adapt under these new systems. That is, HMOs, PPOs and other managed care plans still appear to be the main choices in a defined care environment, so they are in fact a part of the system.

Assessment

Another challenge with a defined health benefit program is that the concept of risk-pooling becomes more difficult. In traditional employer-sponsored plans, rates are usually based on the pool of employees; a chronically ill employee who tries to find insurance independently may face rates drastically higher than if they had participated in an employer-sponsored plan.

MORE: www.CertifiedMedicalPlanner.org

Conclusion

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Filed under: Book Reviews, Financial Planning, Glossary Terms, Investing, Retirement and Benefits, Sponsors | Tagged: 401-k, 403-b, david marcinko, defined contribution plan, defined denefits plan, employee benefits, employee funding, employer funding, health benefits, Health Capital Consultants, HMO, hope hetico, IRA, legacy plan, PPO, retirement benefits, retirement planning, robert james cimasi, www.healthcarefinancials.com, www.healthdictionaryseries.com | 1 Comment »

Understanding the Emergency Medical Treatment and Active Labor Act

Posted on April 26, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

An Important and Contemporary Issue – Once Again

[By Patricia Trites; MPA, CHBC, CMP™ (Hon) with Staff Reporters]

The Emergency Medical Treatment and Active Labor Act (EMTALA) is receiving increasing scrutiny from prosecutors during these times of financials stress and credit tightening. The statute is intended to ensure that all patients who come to the emergency department of a hospital receive care, regardless of their insurance or ability to pay. Both hospitals and physicians need to work together to ensure compliance with the provisions of this law.

Triad of Requirements

EMTALA imposes three fundamental requirements upon hospitals that participate in the Medicare program with regard to patients requesting emergency care.

First, the hospital must conduct an appropriate medical screening examination to determine if an emergency medical condition exists.

Second, if the hospital determines that an emergency medical condition exists, it must either provide the treatment necessary to stabilize the emergency medical condition or comply with the statute’s requirements to affect a proper transfer of a patient whose condition has not been stabilized. A hospital is considered to have met this second requirement if an individual refuses the hospital’s offer of additional examination or treatment, or refuses to consent to a transfer, after having been informed of the risks and benefits of treatment.

Third, EMTALA’s requirement is activated if an individual’s emergency medical condition has not been stabilized.

Hospital Transfers

A hospital may not transfer an individual with an unstable emergency medical condition unless:

(1) the individual or his or her representative makes a written request for transfer to another medical facility after being informed of the risk of transfer and the transferring hospital’s obligation under the statute to provide additional examination or treatment;

(2) a physician has signed a certification summarizing the medical risks and benefits of a transfer and certifying that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the transfer outweigh the increased risks; or

(3) a qualified medical person signs the certification after the physician, in consultation with the qualified medical person, has made the determination that the benefits of transfer outweigh the increased risks, if a physician is not physically present when the transfer decision is made. The physician must later countersign the certification.

On-Call Responsibilities

One area of particular concern is physician on-call responsibilities. Physician practices whose members serve as on-call hospital emergency room physicians are advised to familiarize themselves with the hospital’s policies regarding on-call physicians. This can be done by reviewing the medical staff bylaws or policies and procedures of the hospital that must define the responsibility of on-call physicians to respond to, examine, and treat patients with emergency medical conditions. Physicians should also be aware of the requirement that, when medically indicated, on-call physicians must generally come to the hospital to examine the patient. Patients may be sent to see the on-call physician at a hospital-owned contiguous or on-campus facility to conduct or complete the medical screening examination due to the following reasons:

all persons with the same medical condition are moved to this location;
there is a bona fide medical reason to move the patient;
qualified medical personnel accompany the patient; and
teaching physicians may participate.

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Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: "Doctors Only", Career Development, Ethics, Glossary Terms, Health Insurance, Health Law & Policy, iMBA, Inc., Managed Care, Practice Management, Recommended Books | Tagged: CMP, david marcinko, emergency care, emergency department, Emergency Medical Treatment and Active Labor Act, emergency room, EMTALA, ER, healthcare, hope hetico, hospital, medicare, Pati Trites, www.healthcarefinancials.com, www.healthdictionaryseries.com | 9 Comments »

Healthcare Projections and the US Budget 2007-09

Posted on April 26, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Issues and Challenges for Obama Administration Reform

By Staff Reporters

Read the complete testimony and statement of Peter R. Orzag, OMB Director, to the US Senate, dated June 21, 2007.

For more information:

Congressional Budget Office

Second and D Streets; SW

Washington, DC 20515

Link: 06-21-healthcarereform

Assessment

Now, almost two years later, and with the new Obama Administration, has your opinion changed on the potential of healthcare reform; why or why not?

Conclusion

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Filed under: Career Development, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Managed Care | Tagged: COngressional Budget Office, healthcare reform, Obama Administration, OMB, OMB Director, Orzag testimony on health reform, Peter Orzag, US Senate | Leave a comment »

Understanding Modern Health Plan Delivery Models

Posted on April 25, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

By Defining Terms and Concepts

Staff Writers

www.HealthcareFinancials.com

Here are four important health care delivery models that should be understood by all financial advisors, their clients, patients and the public:

1. PHYSICIAN ORGANIZATION (PO)

A PO is a group of physicians banding together, usually for the purpose of contracting with managed care entities, or to represent the physician component in a Physician Hospital Organization. The PO is a managed care contracting entity owned by and composed exclusively of physicians. The PO tends to be more tightly controlled in terms of members and adherence to treatment protocols than an Independent Physician Association. POs typically share information systems, claims-processing procedures, financial data, medical records, and other technical support functions.

2. PHYSICIAN PRACTICE MANAGEMENT CORPORATION (PPMC)

A firm that purchases physicians’ practices in exchange for a percentage of the gross receivables. The PPMC leases the office back to the doctor or employs the doctor on a salaried basis. The PPMC then contracts with the areas MCOs.

3. POINT OF SERVICE PLAN (POSP)

A type of managed care plan that allows members to choose whether to seek medical care within the plan’s network or seek medical care out of network at the point of service (i.e., at the time services are rendered). It allows members to pay little or nothing, if they stay within the established HMO delivery system. But, it also permits members to choose and receive services from an outside doctor, any time, if they are willing to pay higher co-payments, deductibles and possibly monthly premiums. It is also called an “open-ended” plan.

4. PREFERRED PROVIDER ORGANIZATION (PPO)

A PPO is a select, approved panel of physicians, hospitals, and other providers who agree to accept a discounted fee schedule for patients and to follow utilization review and pre-authorization protocols for certain treatments. It is a system in which a payer negotiates lower prices with certain doctors and hospitals. Patients who go to a preferred provider get a higher benefit — for example, 90% or 100% coverage of their costs — than patients who go outside the network.

Assessment

Link: www.HealthDictionarySeries.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated?

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Filed under: "Advisors Only", Book Reviews, Career Development, Glossary Terms, Health Insurance, iMBA, Inc., Managed Care, Practice Management | Tagged: david marcinko, dictionary of health insurance and managed care, financial advisors, health maintenance organization, HMO, hope hetico, managed care organization, MCO, physician organization, physician practice management corporation, PO, point of service health plan, POS, PPMC, PPO, preferred provider organization, www.healthdictionaryseries.com | 2 Comments »

Sherlock Expense Evaluation Report [SEER]

Posted on April 24, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Plan Management Navigator

By Marco Georeno

Ph: 215-628-2289

Please find attached the April 2009 edition of Plan Management Navigator. In it we provide an update on the timing of the Blue Cross Blue Shield universe and the Independent / Provider-Sponsored editions of the Sherlock Expense Evaluation Report (SEER). In addition, we expect to circulate the benchmarking surveys for the Medicaid and Medicare universes on or about June 1st, for completion by July 20^th, 2009.

Benchmarking Studies

If you are interested in participating in our benchmarking studies please contact us as soon as possible. Additional information about SEER is available at www.sherlockco.com/seer.shtml or by contacting Doug Sherlock (sherlock@sherlockco.com).

Best Practices for the Healthcare Enterprise

We also endeavor to provide an enterprise view of best practice. Best practice is typically considered to be the most efficient way of achieving a desired outcome. We believe that the best way of determining the best practice in its most practical application is to start with an overall objective and weigh all particular practices in light of how they contribute to that overall objective.

In that vein, over the next several months, Sherlock Company will be offering web conferences focused on best practices. The first conference will address activities within Customer Services, as well as activities or effects in other functional areas. This web conference will be held on Wednesday May 20th at 2:30 PM, Eastern Time. The costs will be $225. Participation is free of charge to health plans participating in our 2009 benchmarking studies. If you are interested in participating, please email Erin Sawchuk (erinsawchuk@sherlockco.com) or call at 215-628-2289.

Assessment

This edition of Navigator also discusses the latest private health plan Dashboard results for the trailing three months ended January 31, 2009.

Link: navigator

Sincerely,
Sherlock Company

Marco Georeno – Analyst
mgeoreno@sherlockco.com

Fax: 215-542-0690

Conclusion

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Filed under: "Advisors Only", "Doctors Only", Breaking News, Career Development, Health Economics, Managed Care, Monthly Reports, Practice Management, Research & Development, Sponsors | Tagged: Blue Cross, Blue Shield, douglas sherlock, Goereno Marco, health econoics, health maintenance plans, healthcare enterprise, Healthcare Finance, HMO, Managed Care, MCO, Medicaid, medicare, Plan Management Navigator, SEER, Sherlock Company, Sherlock Expense Evaluation Report | Leave a comment »

Understanding the Health Maintenance Organization Delivery Model

Posted on April 24, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Defining Terms and Concepts

By Staff Writers

www.HealthcareFinancials.com

An HMO is a legal corporation that offers health insurance and medical care. It is a health care delivery system that provides comprehensive services for subscribing members in a particular geographic area. Most HMO care is provided through a managed network made up of MD/DOs, hospitals, and other allopathic/osteopathic professionals selected by the HMO. HMO enrollees are required to obtain care from this network of providers in order for their care to be covered, except in cases of emergency. All the care the members may need is paid for by the single monthly fee, plus nominal co-payments. HMOs typically offer a range of health care services at a fixed price (capitation).

Different Types

The types of HMOs are:

1. STAFF MODEL: Organization owns its clinics and employs its doctors.

2. GROUP MODEL: Contract with medical groups for services.

3. INDEPENDENT PHYSICIAN ASSOCIATION (IPA) MODEL: IPA contract that in turn contracts with individual physicians.

4. DIRECT CONTRACT or NETWORK MODEL: Contracts directly with individual physicians.

5. MIXED MODEL: Members get options ranging from staff to IPA models.

6. OPEN-PANEL MODEL: A managed care plan or HMO where members can see any provider for an extra premium cost.

Assessment

Link: www.HealthDictionarySeries.com

Conclusion

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Filed under: "Ask-an-Advisor", Book Reviews, Career Development, Glossary Terms, Health Insurance, iMBA, Inc., Managed Care | Tagged: david marcinko, Dctionary of Health Insurance and Managed Care, DDS, DO, DPM, Group Model HMO, health maintenance organization, HMO, hope hetico, IPA, Managed Care, MD, medical network, mixed model HMO, open panel HMO, staf model HMO, www.healthdictionaryseries.com | 1 Comment »

Alternative Design Options for a Public Health Plan

Posted on April 23, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

New Lewin Group Report Examines Potential Impact

[By Staff Reporters]

April 6, 2009

FALLS CHURCH, VA – The Lewin Group released a report titled “The Cost and Coverage Impacts of a Public Plan: Alternative Design Options.” The report examines potential impacts that a “public health plan” might have in competing for enrollment with the private insurance industry.

Healthcare Reform

As ME-P readers are aware, a public plan is currently being considered in a number of health reform proposals being considered by President Obama and the US Congress. This analysis enhances prior work done by The Lewin Group of the major party presidential candidate’s health reform proposals, during the 2008 campaign, as well as more recent analyses of the Congressional plans now being considered. The report estimates the impact on cost and coverage based on different levels of eligibility and reimbursement rates.

Key Findings Review

According to The Health Care Blog writer Robert Laszewski, key study findings include:

If Medicare payment levels are used in the public plan, premiums would be up to 30 percent less than premiums for comparable private coverage. On average, the monthly premium in the public plan for a typical benefits package would be $761 per family compared with an average of $970 per family in the private market for the same coverage.
If as the President proposed, eligibility is limited to only small employers, individuals and the self-employed, public plan enrollment would reach 42.9 million people. The number of people with private coverage would fall by 32.0 million people. If private payer reimbursement levels are used by the public plan, enrollment would be lower, with only 10.4 million people switching to the public plan from private insurance.
If the public plan is opened to all employers as proposed by former Senators Clinton and Edwards, at Medicare payment levels we estimate that about 131.2 million people would enroll in the public plan. The number of people with private health insurance would decline by 119.1 million people. This would be a two-thirds reduction in the number of people with private coverage (currently 170 million people). Here again, if the higher private payer levels are used, enrollment in private insurance would decline by only 12.5 million people.
Assuming Medicare reimbursement rates and eligibility for all individuals and employers, provider net income would decline under this public plan proposal, even after accounting for reduced uncompensated care and increased utilization for the newly insured. Net hospital revenues would fall by $36 billion (4.6 percent), and physician net income would fall by $33 billion (6.8 percent). If eligibility is restricted to individuals and small firms, net hospital revenues would actually increase by $11.3 billion due to the increase in newly insured individuals. But net physician incomes would decline by $3.0 billion.

Assessment

Full report: lewin-report

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance | Tagged: lewin group, medicare, national healthcare, obama, public health, self-employed, Senator Clinton, Senator Edwards, socialized medicine, uncompensated care | 4 Comments »

Understanding Collateralized Mortgage Obligations

Posted on April 23, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Defining Terms and Concepts for Medical Professionals

By Staff Reporters

www.HealthcareFinancials.com

A CMO is a debt security backed by mortgages. These mortgage pools are usually separated into different maturity classes called tranches (from the French word for “slice”). The securities were issued by private issuers, as well as the Federal Home Loan Mortgage Corporation (Freddie Mac). As the mortgages were usually government-guaranteed, CMOs usually carried AAA ratings until their current financial meltdown. The early versions of CMOs were known as “plain vanilla,” but recent developments gave us PACs (planned amortization certificates) and TACs (targeted amortization certificates); among too many others. They were all variations on how principal repayments in advance of maturity date were treated.

Assessment

Link: www.HealthDictionarySeries.com

Conclusion

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Healthcare Organizations: www.HealthcareFinancials.com

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About Medlytix.com

Posted on April 22, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

On Patient Payment Behavior Scoring

[By Staff Reporters]

Medlytix is a healthcare consulting and technology firm specializing in the field of predictive payment analytics. Utilizing sophisticated data mining and scoring strategies, the company reports enhanced hospital revenue cycles and collections for healthcare providers across the country.

The Business of Healthcare

It is a fact that consumers treat medical bills differently than other financial obligations. So, Medlytix customizes revenue-enhancement strategies to target each provider’s individual market.

Suite of Services

All stakeholders benefit from a more efficient operation – from provider to patient. Medlytix offers expertise and technology to enhance the cash conversion and revenue cycle by eliminating inefficiencies while maximizing collections. A customized strategy that’s based on specific needs is crafted. Three offerings include: 1.Medilyzer, 2. Predyx, and 3. Consulting services to improve the bottom line.

Non-Profits Hospitals

Non-profit hospitals exist to serve their communities with quality healthcare accessible to all. By helping hospitals pinpoint charity-care patients who are truly in need, the focus is on the patient.

Assessment

The mission of Medlytix is to build a healthier bottom line for hospitals. As fiscal strength improves, better hospitals provide better service to patients.

Conclusion

How does this relate to emails? Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Accounting, Health Insurance, Healthcare Finance, Information Technology, Practice Management | Tagged: behavior scoring, data mining, healthcare economics, Healthcare Finance, hospital cash conversion, hospital reenue cycle, medilyzer, Medlytix, non-profit hospitals, predictive begavior, predictive payment analytics, predyx | 1 Comment »

Become a Published Print Author with Us

Posted on April 22, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

The Business of Medical Practice [3^rd Edition]

By Hope Rachel Hetico RN, MHA, CMP™

[Managing Editor]

Dear Colleagues,

As you may know, we are commencing work on the third edition of our best selling book: The Business of Medical Practice

TOC 1st: http://www.amazon.com/Business-Medical-Practice-Maximizing-Doctors/dp/0826113117/ref=sr_1_8?ie=UTF8&s=books&qid=1231111232&sr=1-8

TOC 2nd: http://www.springerpub.com/prod.aspx?prod_id=23759

Invitation to Contribute

Accordingly, we would be honored for you to consider contributing a new or revised chapter, in your area of expertise, for a low-effort but high-yield contribution. Our goal is to help physician colleagues and management executives benefit from nationally known experts, as an essential platform for their success in the healthcare 2.0 business industry. Many topics are still available: [health accounting and costing; law, policy and administration; Medicare fraud and abuse; coding and insurance; HIT, grid and cloud computing; finance and economics, competitive models, collaboration and leadership, etc].

Support Always Available

Editorial support is available, and you would enjoy increasing subject-matter notoriety, exposure and public relations in an erudite and credible fashion. As a reader, or preferably a subscriber to the ME-P, your synergy in this space may be ideal. Time line for submission of a 5,000-7,500 word chapter is ample, and in a prose writing style that is “wide, not deep.”

A Health 2.0 Initiative

And, be sure to address health 2.0 modernity. Update chapters from the second edition are also available.

Definition: https://healthcarefinancials.wordpress.com/2008/09/12/emerging-healthcare-20-initiatives

Assessment

Please contact me for more details, if interested. A best selling-book is rare; while a third-edition volume even more so. Join us in this project. Regardless, we trust you will remain apostles of our core ME-P vision, “uniting medical mission and financial profit margin”, promoting it whenever possible.

Front Matter Link: frontmatter1advancedbusinessmedicine4

Contact Info:

MarcinkoAdvisors@msn.com

770.448.0769

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FINANCE:Financial Planning for Physicians and Advisors
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Filed under: "Advisors Only", "Doctors Only", Accounting, Book Reviews, Contest Entrance, Ethics, Experts Invited, Health Economics, Health Insurance, Healthcare Finance, iMBA, Inc., Information Technology, Marketing & Advertising, Media Mentions and PR, Nominations Sought, Practice Management, Quality Initiatives, Recommended Books, Research & Development, Risk Management, Sponsors | Tagged: Accounting, authors, authors books, Best Medical Practices Workgroup, best seller, Business of Medical Practice, CEO, CFO, contributors, COO, cost acounting, CXO, david marcinko, DDSs, DOs, editors, experts, health 2.0, health 3.0, health administratino, health administration, health journalists, health policy, healthcare business, hope hetico, IT, lawyers, MDs, medical administration, medical management, medical practice management, nurse executives, nurses, physician-executives, practice administration, Practice Management, print journalism, publishing, publishing collaboration, third edition, writers, writing, www.medicalbusinessadvisors.com | Leave a comment »

Will the SEC Protect eMRs [Welcome to my Healthcare Nightmare]

Posted on April 21, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A Frightening Progressive Policy Institute [PPI] Report – Redeux

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

It is no surprise to ME-P readers, that I am a big fan of Dr. Regina E. Herzlinger, the Nancy R. McPherson professor of business administration and chair at Harvard Business School. I quote her often, in our books, despite her recent MA fiascos chronicled here. I am also a competitive medical analyst, IT devotee and health economist, who was a CFP® designee for more than a decade; before my fiduciary reformation. In her books, Creating New Healthcare Ventures and Market Term in Healthcare, Regi rightly states that many medical professionals are becoming depressed at the current state of affairs in healthcare, and want to give up their careers, entirely. We all know that many doctors, like me, no longer wish their kids to follow our professional footstep [Busia; please don’t roll-over in your grave – I know what I am doing – RIP].

But, is the same emerging trend true for FAs?

Medical Career Changers

For example, Gigi Hirsch, MD, a former ER physician and instructor at Harvard Medical School grew so disenchanted with clinical medicine, that she ditched her career and started her own business, MD IntelliNet, in Brookline, Mass. The company places doctors in non-traditional jobs by pairing them with venture capitalists and other businesses seeking physicians. Of course, this re-engineering and formal re-education has been the experience of my personal career journey, as well.

“Don’t Give up Practice, Yet”

And, Herzlinger implores in her book, Market Driven Healthcare, “don’t give up practice, yet.”

Patients Concerned Too

On the other hand, patients and healthcare consumers are also worrying about the looming so-called governmental free-for-all regarding healthcare delivery, mandated benefits and taxes, federally mandated electronic medical records, and data collection reportage and security; etc. Can you say “Big Brother” or “Command and Controll?”

Assessment

So, now may be the time to review Regi’s op-ed piece and policy report, penned for the PPI back, in 1999. It concerns patient and consumer healthcare protections. And, in this time of an Obama administration push for national healthcare – perhaps a prescient word to the wise might be sufficient.

Link: herzlinger

Conclusion

Your thoughts and comments on this Medical Executive-Post are appreciated? Should there be a healthcare SEC surrogate, much link the financial SEC? Or, would another governmental agency be as incompetent as Wall Street’s SEC and FINRA? Do we want FA wonks directing our healthcare needs? As an SEC controlled broker-dealer, and/or FA drone, should you even pursue same in your financial planning practice? What about the independent’s, CFPs and RIA’s? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to this ME-P. It is fast, free and secure.

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Filed under: "Advisors Only", "Ask-an-Advisor", "Doctors Only", Alerts Sign-Up, Book Reviews, Breaking News, Career Development, Ethics, Financial Planning, Managed Care, Op-Editorials, Practice Management, Quality Initiatives, Research & Development | Tagged: CFP, CMP, Creating New Healthcare Ventures, david marcinko, fiduciary financial advisors, financial advisors, FINRA, Gigi Hirsch, health economists, MA, Market Term in Healthcare, MD Intellinet, Medicare Advantage, ntional healthcare, obama, progressive policy institute, regina herzlinger harvard business school, SEC, socialized medicine | 5 Comments »

Calling for CFP® Fiduciary Status, Real Education and Higher Duty

Posted on April 19, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Marcinko Predates Basu – Joins in on Promoting Same

[By Ann Miller; RN, MHA]

Executive Director

Editor’s Note:

We cut and pasted this verbatim anonymous comment, obtained from the trade magazine – Financial Advisor [FA] online – for its pointed charges important to the currently contentious topic of CFP mark status. Although emotional, and borderline abusive, it may represent more reality; than not.

The Letter

Liars and Frauds
Grossly Incompetent
Conveniently Stupid
Simply Unethical

The bulk of the commentary seems to focus on ethics and fiduciary duty to clients. It does not now, nor has ever existed. Fiduciary:

“As fiduciaries, financial planners must make fair and complete disclosure of all material facts and must employ reasonable care to avoid misleading their clients. The utmost good faith is required in all their dealings. Simply put, fiduciaries must exhibit the highest form of trust, fidelity and confidence, and are expected to act in the best interest of their clients at all times.”

The bulk of planner’s violate this tenet and always have. A fiduciary MUST be legal. The idea that one is practicing ethically while never being legal is an affront to any rational person. Or; shall we simply say a “prudent man” at as minimum.

As a fact, about 35 states require licensing that planners don’t want to hear about, never mind adhere to. California – with 8,000 CFPs – has only ONE that is fully licensed and legal to offer comprehensive fee services. Where is the outrage from CFP®s regarding this – and what the other 35 states demand?

A Conspiracy?

Nothing at all: The Board has actively engaged in a conspiracy of silence regarding such duty. NAPFA is a joke and always has been regarding high standards. Yet not one CFP® apparently even cares. That is being a fiduciary? It goes further. The UC system in California was also made aware of this deception more than a decade ago – yet did nothing. The illegal planners/instructors were left to “instruct and guide” new planners to the same level of illegality and fraud. You simply have a wholesale violation of integrity and honesty permeates the educational system and no one cares. I am not sure California Lutheran knows of the deception either. I doubt it. Does that make the lack of integrity and knowledge any the less worse? No.

You have to know what is required legally to perform a function. Every commentator would immediately notify regulators if a physician or attorney was practicing illegally. Yet; nothing here. Is this a double standard by CFPs etc, all to allow themselves a free pass from licensing? Sure.

Every officer, director and most staff members of the Board since Bob Goss has been aware of the fraud. All on formal written record since 1995, at the very least. Not one CFP® in this commentary venue has even bothered to address illegal and unethical activity- yet while extolling the virtues of the organization and themselves. What about the New Disciplinary Board Members? Are they not aware of the breach? If not, why not. Incompetency? If they do now, then why have they done nothing? Conveniently stupid – worse?

Steven Covey noted:

“Integrity means avoiding any communication that is deceptive, full of guile or beneath the dignity of people. A lie is any communication with intent to deceive. Whether we communicate with words or behavior, if we have integrity, our intent cannot be to deceive.”

FA is also aware of the lies and deception and at least has allowed this discussion. But to have further commentary from Board officers extolling the virtues of their standards and the highest integrity is disingenuous at best and a fraud at its worst.

Shame

Shame on all of you for not forcing the issue – of being a true fiduciary? But then again, worse yet, we have these same organizations and people deceptively going to Congress to instill this level of a breach of duty to the American public. Yet, hardly an outcry because the deception is so good and because members would benefit. So we have a benefit by deception.

“it is a lot easier to talk about your ethics than to live up to them.”

The standards might be fine. But who cares if they do not have to be adhered to. Is that not the real question?

Link http://www.fa-mag.com/online-extras/4064-weighing-the-cfp-mark-the-debate-continues.html

Assessment

Contrary to the above and CFP BoS requirements, the Certified Medical Planner program demands a college degree [with verifiable proof], a written and signed statement of legal fiduciary accountability at all times, and CEs consisting of a published dissertation, not mere annual lucre www.CertifiedMedicalPlanner.org

The CMP™ Experience

Now, in as much as I am the ED for our CMP™ online program, I vet most applications. The prioritized reasons for matriculation rejection are: 1] unwillingness / inability to accept fiduciary status while blaming it on BDs, 2] lack of at least an undergraduate college degree, and 3] absolute “panic” regarding our writing and publication requirements.

Conclusion

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Filed under: "Advisors Only", Alerts Sign-Up, Breaking News, Career Development, Ethics, Financial Planning, Op-Editorials, Quality Initiatives, Research & Development | Tagged: Bob Goss, california lutheran university, CFA, CMP, CPA, david marcinko, financial advisor magazine, financial fiduciary, financial planner, MBA, NAPFA, PhD, Somnath Basu, Steven Covey | 22 Comments »

About Certified Medical Planner™

Posted on April 18, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

SPONSOR NOTICE

Top 10 Reasons to Become a

Certified Medical Planner™

1. Expertise: Provide health economics, business and financial advice to physicians.

2. Credibility: Gain health industry recognition and fiduciary clout.

3. Opportunity: Focus on the lucrative and expanding physician advisory niche.

4. Recognition: Join a select group of advisory experts.

5. Distinction: Become quality; rather than product driven.

6. Achievement: 500 hours of financial, health economics and management education.

7. Evidence: Validate deep healthcare industry knowledge.

8. Resource: CMP™ text and hand books, dictionaries, and institutional print journal.

9. Distinction: Set yourself apart with our chartered logo and trade-mark identity.

10. Commitment: Become the “go-to” financial advisor for all medical professionals.

www.CertifiedMedicalPlanner.com

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Filed under: "Advisors Only", Career Development, CMP Program, Ethics, Financial Planning, Health Economics, iMBA, Inc., Managed Care, Marketing & Advertising, Practice Management, Quality Initiatives, Sponsors | Tagged: certified medical planner, CFP, CMP, doctors, fiduciary advisor, financial advisor, financial planner, medical management, nurses, physician advisors, Practice Management, www.certifiedmedicalplanner.com | 2 Comments »

About MyFax.com

Posted on April 17, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A New Internet Enabled SaaS Business Communication Tool

[By Staff Reporters]

MyFax is the fastest-growing Internet fax service used by individuals, small, medium and large businesses to send and receive faxes using existing email accounts or the web. MyFax offers services in North America and Europe, including the United Kingdom, to industries recognized among the fastest-growing adopters of Internet fax including finance, insurance, real estate, healthcare, transportation and government.

Customer Base

More than 15,000 new customers subscribe to MyFax each month. MyFax is part of a total Software-as-a-Service (SaaS) business communications offered by Protus that also includes my1voice feature-rich virtual PBX service and Campaigner, an email marketing service enabling organizations to have highly personalized one-to-one email dialogues with their customers.

Assessment

Additional information is available at www.campaigner.com , www.my1voice.com or www.myfax.com .

Contacts:

Sue Rutherford, Protus

(613) 733-0000 x 519 or srutherford@protus.com

Tracy Shryer, Tech Image

847-279-0022 x230 or tracy.shryer@techimage.com

Conclusion

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Filed under: Information Technology, Practice Management | Tagged: campaigner.com, Darrell Pruitt, EHRs, EMRs, ePRs, HIPAA, my1voice.com, myfax.com, PBX, protus, SaaS, sue rutherford, tech image, tracy shryer, www.myfax.com | 7 Comments »

Dr. Somnath Basu Replies to the CFP® [Mis] Trust Controversy

Posted on April 16, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Restoring Trust in the CFP® Mark … the Ongoing Saga

By Ann Miller, RN, MHA

[Executive Director]

According to Professor Somnath Basu, PhD; Director – California Institute of Finance at the California Lutheran University,

A painful truth is that many financial practitioners are sales people masquerading as planners or advisors in an industry whose ethical practices have a shameful track record.

Restoring Trust in the CFP® Mark

Basu’s article, published in the Financial Advisor online news magazine on April 6, 2009, struck a chord with our ME-P readers the last few days. More than 75 opinions, calls, emails and faxes were received commenting on it.

Link: http://www.fa-mag.com/online-extras/4037-revisiting-cfp-credentialing.html

A Trickle – Not a Barrage

However, we did not receive the barrage of fire and brim-stone that one would have expected in the past [sans several abusive miscreants], attempting to feebly parse each phrase to an informed audience of insiders. Perhaps it is the dismal economy, the shenanigans of Wall Street, or the ire of blind-sided clients that has stunned many financial advisors and Certified Financial Planners® into sober silence – or shall we dare say it – shame. In fact, one caller ruefully said,

“Most everything that Basu and Marcinko said is true. We all know it, even though we pretend not to with a “nod and a wink” to the blind and trusting public; all while posturing as experts to friends and family. But, that’s not what bothers me the most about this whole situation … What I really hate now is that everyone else knows it too!”

I Jealously “Shake my Fist” at Somnath Basu

Rather than individual shame, the general reaction to Dr. Basu’s article – as well as this follow-up ME-P of Dr. David Edward Marcinko MBA [Publisher-in-Chief] – was an almost surreal and collective acceptance of its’ accuracy. The CFP® mark – while certainly premier in the flagging financial services industry – still leaves far too much to be desired in terms of education, competency, disclosure, ethical standing and real professionalism. And, except for some rather Herculean marketing advancements; the CERTIFIED FINANCIAL PLANNING Board of Standards’ stated goal of attaining professional stature for the marks, has fallen far short – or even regressed the past decade – seemingly abandoned for the sake of growth.

Link:https://healthcarefinancials.wordpress.com/2009/04/09/i-jealously-shake-my-fist-at-somnath-basu/

Stepping Up to Redemption and Independence

Since contemplative reflection is the first step toward redemption, we now ask all financial advisors, IAs, wealth managers, etc., and especially the CFP BoS, to step up their game and place client interests first – in writing – by demanding ERISA-like fiduciary status at all times. The public will demand it; soon enough – we guarantee it.

Link: www.fi360.com

Link: https://healthcarefinancials.wordpress.com/2009/03/01/an-interview-with-bennett-aikin-aif%c2%ae/

Oh; to be Treated as Adults!

Now, wouldn’t it be a relief for example, if the arcane rules, and feigned or failed microscopic/micromanaged oversight of the SEC, FINRA and various BDs – that we all abhor – might be someday rendered obsolete? Wouldn’t it be nice to be treated as an adult; not a juvenile employee in need of constant supervision? Then, the march to autonomy may begin, as FAs/IAs/CFP® become treated as professionals, and not sub servant agents, or …. registered representatives.

Assessment

Therefore, we personally thank Dr. Basu’s for his attached and unedited reply, specifically written and personally addressed to our Publisher and all ME-P readers and subscribers:

Dear Dave:

My response is attached.

Best regards.

Som (Dr. B)

Link: soms-reply1

Conclusion

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Dictionary of Health Economics and Finance
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Broker Compensation for Debt-Based Securities

Posted on April 15, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Commission Methods for Selling Investments

By Staff Reporters

Brokers earn commissions on debt instruments based on the spread, or markup, between the price at which the broker can secure the bond and the price at which it is sold.

Bond Funds

In the case of bond funds, the fund charges a management fee and/or an expense fee. There may or may not be a load, or commission, paid to a broker.

Assessment

For more terminology information, please refer to the Dictionary of Health Economics and Finance.

www.HealthDictionarySeries.com

Conclusion

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Filed under: Financial Planning, Investing, Portfolio Management | Tagged: bond brokers, bond fees, bond funds, bond price, bonds, broker, commissions, debst instruments, debt based securities, load, markup, sales load | Leave a comment »

Military Health System Records

Posted on April 15, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Expanding PHR Pilot Testing

By Staff Reporters

According to Paul McCloskey, on April 08, 2009, the Military Health System [MHS] will extend its test of personal health records at Madigan Army Medical Center in Tacoma, Wash., to two additional health care venues in an attempt to test the technology in larger populations and more diverse care settings.

MiCare PHR Focus

The new projects will focus on using the MiCare Personal Health Record [PHR] as a tool for care coordination and a mechanism for patients to share health records across a mix of military and commercial providers and payer organizations, according to Col. Keith Salzman, chief of informatics at Madigan, which is hosting a pilot test of MHS’ MiCare PHR.

Assessment

Link: http://govhealthit.com/articles/2009/04/08/phr-pilot-testing.aspx?s=GHIT_140409

Conclusion

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Filed under: Career Development, Information Technology, Military Medicine, Quality Initiatives | Tagged: chief informatics, CIO, EHRs, electronic medical records, EMRs, Health I.T., health information technology, Keith Salzman, Madigan Army Medical Center, MHS, MiCare, military health system, personal health records, PHRs | 6 Comments »

Allscript’s Glenn Tullman is Video Interviewed

Posted on April 14, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Video Clip from the HIMSS Meeting

By Ann Miller; RN, MHA

[Executive-Director]

There is a major controversy in the modern healthcare community over eMRs and how to pay for them; or even if they are effective in improving medical outcomes. Of course, by eMRs we mean interoperable medical records that span the pan-healthcare ecosystem; and not just the stand-alone digital records that many, if not most, physicians use in their daily practices to some degree or another.

Link: https://healthcarefinancials.wordpress.com/2009/03/10/on-the-hitech-act-of-2009/

Proponents

As readers of the ME-P are aware, one vocal camp supports certification and eMR industry mandates, standards, and governmental initiatives, etc. The recent $20 billion taxpayer input from the Obama Administration, courtesy of HITECH, further emboldens CCHIT and related wonks.

Opponents

One the other hand, one vocal ME-P opponent is dentist Darrell Pruitt. He and many others believe that current eMRs may be too expensive, unwieldy, and counter-productive. This camp advocates a mix of other data sources, technology processes and doctor/patient education to get us where we need to be in terms of improving medial outcomes; quicker and less expensively.

Assessment

Rather than read, research and write more on this controversy, which was apparently a red-hot topic at the recent HIMSS meeting, we have embedded a video link of Glen Tullman [CEO of Allscripts] and Mark Leavitt, [Chair of CCHIT], below.

Link: https://healthcarefinancials.wordpress.com/2009/03/02/cchit-is-prejudiced-and-lacks-diversity-%e2%80%93-an-indictment/

It even includes a clip of Jonathan Bush, CEO of AthenaHealth. And, although they don’t all agree; some common ground may be developing in this controversial issue.

Source: This link originally appeared on The Health Care Blog [THCB], by Matthew Holt.

Link: http://www.thehealthcareblog.com/the_health_care_blog/2009/04/cats-and-dogs-on-film–tullman-leavitt-bush.html#comments

Disclaimer:We are members of AHIMA, HIMSS, MS-HUG and SUNSHINE. We just released the Dictionary of Health Information Technology and Security, with Foreword by Chief Medical Information Officer Richard J. Mata; MD MS MS-CIS, of Johns Hopkins University; and the second edition of the Business of Medical Practice with Foreword by Ahmad Hashem; MD PhD, who was the Global Productivity Manager for the Microsoft Healthcare Solutions Group at the time.

Conclusion

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Filed under: Breaking News, Career Development, Experts Invited, Information Technology, Interviews, Videos | Tagged: AHIMA, Ahmad Hashem, Allscripts, AthenaHealth, CCHIT, CMIO, Darrell Pruitt, Dictionary Health Information Technology Security, eDRs, EHRs, EMRs, Glenn Tullman, health information technology, HIMSS, HIT, HITECH, IT, Johns Hopkins, Jonathan Bush, Mark Leavitt, Matthew Holt, Microsoft Healthcare Solutions, MS-HUG, MSFT, obama, Richard Mata, SUNSHINE, THCB, www.healthdictionaryseries.com | 20 Comments »

GAO “Stings” FDA and HHS

Posted on April 14, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Bogus Medical Products and Human Testing

[By Darrell K. Pruitt; DDS]

On March 27, 2009, I found the following Associated Press article about a Government Accounting Office (GAO) sting operation. For dentists who are awaiting the final rules from the FDA on the toxicity of amalgam, expect emotional-capricious and expensive. Forget about science, or even logic. For physicians awaiting HHS-supported usability in eMRs … well, good luck.

The HHS – Institutional Review Board

Recently, the GAO successfully gained approval from an HHS-registered institutional review board (IRB) for a bogus and dangerous medical product to be used in human testing. An independent IRB member called pouring a liter of the mystery product into the stomach of a woman following surgery the “riskiest thing I’ve ever seen on this board.”

Daniel Dueber Responds

So what did Daniel Dueber, CEO of the careless IRB, have to say in defense of his company? Since there is no defense, what could he say? According to the AP article, he chose to attack the GAO instead:

“The review board that fell for the GAO ruse, Coast IRB LLC, of Colorado Springs, charged that the GAO violated federal and state criminal laws by falsely representing itself to be a medical device company and forging a medical license. ‘We got hoodwinked,’ said Daniel Dueber, Coast IRB’s chief executive.”

Bart Stupak Responds

Representative Bart Stupak, a Michigan Democrat and chairman of the House Energy and Commerce Committee’s oversight and investigations panel, replied,

“You didn’t get hoodwinked. You took the bait – hook, line, and sinker.”

That’s not all. For those who hoped for rational and well-considered decisions from the Department of Health and Human Services in the Obama administration, it might disappoint some to learn that the GAO was also successful in registering a fictitious IRB.

Assessment

The president of the fake board is a dog named Trooper. If we end up with a Cabinet Secretary at HHS who is a dog-lover as well as a tax-payer, will he or she protect and feed Trooper?

Link:

http://www.boston.com/business/healthcare/articles/2009/03/27/gao_team_wins_approval_for_fake_medical_product

Conclusion

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Filed under: Alerts Sign-Up, Breaking News, Career Development, Ethics, Information Technology, Managed Care, Practice Management, Research & Development | Tagged: Bart Stupak, Daniel Dueber, Darrel Pruitt, dentists, FDA, GAO, Government Accounting Office, HHS, House Energy and Commerce Committee, Institutional Review Board, IRB | 4 Comments »

On Continuity of Medical Care and HIMSS

Posted on April 13, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Considering Pay-for-Retention [P-4-R]

By Darrell K Pruitt; DDS

Here is the question on lots of minds these days; how can we change the way medical providers are paid so they are both incentivized and adequately compensated to provide consistent, high-quality, patient-centered medical homes?

My Novel Idea

Here is a solid, common sense idea; increase providers’ pay gradually according to how long the doctors retain patients – who are free to choose any doctor they wish. Consistency is the mortar of a medical home [i.e., pay-4-retention].

An Ounce of Prevention

If prevention, which predates eHRs by thousands of years, is more than just a modern buzzword, the nation can still shave much more expense from health care by promoting continual, personalized care for consumers than from digital health records alone – void of prevention incentives. Who in the audience still cannot understand that concept? Think of it this way. How do business leaders in the land of the free retain the best employees? They pay bonuses. Even waiters get tips to encourage interest in providing service consumers will return for. What do US physicians get? Guaranteed cuts in their Medicaid payments over the next decade. Physicians no longer encourage their children to become doctors. Surprised? Scared?

Consumers Should Rule

In place of consumers ruling their healthcare in the US, well-positioned, giant stakeholders have persuaded lawmakers to offer physicians bonus money (that will later be taken away), not for curing patients, but for using digital records “in a meaningful manner.” It’s called “Mark and Michael Leavitts’ Clicking for Cash.” Since the rules are made up along the way, they change like the weather. That is why the larger and more progressive medical facilities pay bonuses to retain their best “Coders” and other informatics specialists who keep up with the current Ingenix-styled games in order to maximize profits. It is my opinion that health care IT’s complexity works well with the economic stimulus plan to improve employment in the nation. Entrepreneurial stakeholders will continue to be movie-star popular right up until the complete collapse of Medicare. Then they’ll be impossible to find www.HealthDictionarySeries.com

HIMSS

Have you ever heard of HIMSS?

“The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry’s membership organization exclusively focused on providing leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare.”

– From the HIMSS Web site.

HIMSS Annual Meeting

A week ago, HIMSS convened its annual convention in Chicago. The keynote speakers for the four day event were actor Dennis Quaid; followed by the Chairman and CEO of Kaiser Foundation Health Plan, George C. Halvorson; then the economist and former Chairman, Board of Governors of the Federal Reserve, Alan Greenspan, and finally; Jerry M. Linenger, MD, MSSM, MPH, PhD, Captain, Medical Corps, USN (Ret.), NASA Astronaut, and Space Analyst, NBC News. As one can tell, healthcare IT has lots of momentum. In fact, Dave Roberts, the HIMSS vice president for government relations confidently told Bob Brewin on NextGov.com

“The e-records initiative is an entitlement program like Social Security.”

http://www.nextgov.com/nextgov/ng_20090406_1509.php

Another Entitlement Program – Entitlement for Whom

In Regina Herzlinger’s 2007 book “Who Killed Health Care?” the Harvard School of Business professor argues that entitled stakeholders, including a few ambitious members of HIMSS, are destroying health care in the name of reform. In the first half of her 260 page book, she spells out entrepreneurial malfeasance in simple well-annotated terms. In the last half, she describes why Consumer-Driven Health Care [CDHC] makes sense to her. Professor Herzlinger does not specifically mention the words “medical home” in her book, yet she emphasizes the importance of continuity of care. To promote continuity, she suggests that managed care insurance policies be extended to three years duration and longer. Although she also does not mention dentistry, it is obvious to me that since chronic illnesses like diabetes are exacerbated by poor oral health, continuity of care in dentistry is of special importance. It occasionally takes years to improve some patients’ oral health care. And sometimes we fail.

Assessment

If these assumptions about continuity of care are accurate, it follows that the physical and economic health of the nation depends on long-term medical insurance contracts with employers and freedom-of-choice in providers. So is prevention worth holding ourselves accountable to consumers for once? Maybe it is just me, but I think unprecedented truth in healthcare will soon emerge regardless of stakeholders’ needs for confusion and obscurity. It is called consumerism. And it goes hand-in-hand with the Hippocratic Oath, the free-market and common sense.

Conclusion

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Defining Comparative Medical Effectiveness

Posted on April 13, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

An Emerging Health Economics Issue

By Staff Reporters

Comparative Medical Effectiveness [CME] is not a new healthcare term or health economics concept. Federal initiatives specifically promoting CME were authorized under the Medicare Modernization Act of 2003, but the genesis took root decades before.

Finally … a Hot Topic

Comparative Medical Effectiveness has recently become a hot topic again throughout the arena of health care stakeholders, due to funding and initiatives advanced by the Obama administration, and the positive and negative reactions drawn by different sectors of stakeholders.

Related to Evidence Based Outcomes

For stakeholders including numerous health care policy organizations, the health plan industry, and various health care provider organizations: public and private promotion of Comparative Medical Effectiveness reviews and processes offer the potential for more evidence-based, outcome-benefit or even cost-benefit driven information to improve the health care decision making for all parties. And, for stakeholders concerned about limiting the role of government and third parties in their level of regulation and control over the direct delivery of specific patient care, Comparative Medical Effectiveness may become a lightening rod due to perceived potential as to how the process and information could ultimately be applied.

Definition of the CBO Report

The Congressional Budget Office Report “Comparative Effectiveness: Issues and Options for an Expanded Federal Role” offers the definition that follows:

“As applied in the health care sector, an analysis of comparative medical effectiveness is simply a rigorous evaluation of the impact of different options that are available for treating a given medical condition for a particular set of patients. Such a study may compare similar treatments, such as competing drugs, or it may analyze very different approaches, such as surgery and drug therapy. The analysis may focus only on the relative medical benefits and risks of each option, or it may also weigh both the costs and the benefits of those options. In some cases, a given treatment may prove to be more effective clinically or more cost-effective for a broad range of patients, but frequently a key issue is determining which specific types of patients would benefit most from it. Related terms include cost–benefit analysis, technology assessment, and evidence-based medicine, although the latter concepts do not ordinarily take costs into account.”

Assessment

For related financial, economics, managed-care, insurance, health information technology and security, and health administrative terms and definitions of modernity, visit: http://www.springerpub.com/Search/marcinko

Conclusion

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Filed under: Glossary Terms, Health Economics, Quality Initiatives, Recommended Books, Research & Development | Tagged: CBO, Comparative Medical Effectiveness, COngressional Budget Office, EBM, economics, evidence based dentistry, evidence based medicine, financial, health administration, health information technology, Health Insurance, health plans, healthcare industry, insurance, Managed Care, medical cost-benefits, medical outcomes-benefit, obama, orzag, security | 24 Comments »

More about Healthcare Organizations [Financial Management Strategies]

Posted on April 12, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Our Print-Journal Preface

By Hope Rachel Hetico; RN, MHA, CMP™

As Managing Editor of a two volume – 1,200 pages – premium quarterly print journal, I am often asked about our Preface.

A Two-Volume Guide

As so, our hope is that Healthcare Organizations: [Financial Management Strategies] will shape the hospital management landscape by following three important principles.

What it is – How it works

1. First, we have assembled a world-class editorial advisory board and independent team of contributors and asked them to draw on their experience in economic thought leadership and managerial decision making in the healthcare industrial complex. Like many readers, each struggles mightily with the decreasing revenues, increasing costs, and high consumer expectations in today’s competitive healthcare marketplace. Yet, their practical experience and applied operating vision is a source of objective information, informed opinion, and crucial information for this manual and its quarterly updates.

2. Second, our writing style allows us to condense a great deal of information into each quarterly issue. We integrate prose, applications and regulatory perspectives with real-world case models, as well as charts, tables, diagrams, sample contracts, and checklists. The result is a comprehensive oeuvre of financial management and operation strategies, vital to all healthcare facility administrators, comptrollers, physician-executives, and consulting business advisors.

3. Third, as editors, we prefer engaged readers who demand compelling content. According to conventional wisdom, printed manuals like this one should be a relic of the past, from an era before instant messaging and high-speed connectivity. Our experience shows just the opposite. Applied healthcare economics and management literature has grown exponentially in the past decade and the plethora of Internet information makes updates that sort through the clutter and provide strategic analysis all the more valuable. Oh, it should provide some personality and wit, too! Don’t forget, beneath the spreadsheets, profit and loss statements, and financial models are patients, colleagues and investors who depend on you.

www.HealthcareFinancials.com

Assessment

Rest assured, Healthcare Organizations: [Financial Management Strategies] will become an important peer-reviewed vehicle for the advancement of working knowledge and the dissemination of research information and best practices in our field. In the years ahead, we trust these principles will enhance utility and add value to your subscription. Most importantly, we hope to increase your return on investment [ROI] in some small increment.

Visit and Order Now

Specialty Technical Publishers

8 – 14th Street

Blaine, WA 98230

1-800-251-0381

orders@stpub.com

http://www.stpub.com/pubs/ho.htm

TOC: http://www.stpub.com/pdfs/toc_ho.pdf

Conclusion

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What HMO’s Seek in Private Managed Care Contracts

Posted on April 12, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Whole Sale – Not Retail – Medicine is Growing

By Dr. David Edward Marcinko; MBA, CPHQ, CMP™

[Publisher-in-Chief]

The conversion to managed healthcare, and capitation financing, is a significant marketing force and not merely a temporary business trend. More than 60% of all physicians (MD/DO) in the country are now employees of a MCO, HMO, PHO, etc. Those that embrace these forces will thrive, while those opposed will not.

Achieve Geographic Desirability

After you have evaluated the HMOs in your geographic area, you must then make your practice more attractive to them, since there are far too many physicians in most regions today. The following issues are considered by most MCO financial managers and business experts, as they decide whether or not to include you in their network.

General Standards:

1. Is there a local or community need for your practice, with a sound patient base that is not too small or large? Remember, practices that already have a significant number of patients have some form of leverage since MCOs know that patients do not like swithcing their primary care doctors or pediatrician, and women do not want to be forced to change their Ob/Gyn specialist. If the group leaves the plan, members may complain to their employers and give a negative impression of the plan.

2. A positive Return on Investment (ROI) from your economically sound practice is important to MCO’s because they wish to continue their relationship with you. Often, this means it is difficult for younger practitioners to enter a plan, since plan actuaries realize that there is a high attrition rate among new practitioners. On the other hand, they also realize that more established practices have high overhead costs and may tend to enter into less lucrative contract offerings just to pay the bills.

3. A merger or acquisition is a strategy for the MCO internal business plan that affords a seamless union should a practice decide to sell out or consolidate at a later date. Therefore, such as strategy should include things as: strong managerial and cost accounting principals, a group identity rather than individual mindset, profitability, transferable systems and processes, corporatized form of business, and a vertically integrated organization if a multi-specialty group.

4. Human resources, capital and IT service to synergism with existing MIS framework? This is often difficult for the solo or small group practice and may portend the need to consolidate with similar groups to achieve needed economies of scale and capital, especially in areas of high MCO penetration.

5. Consolidated financial statements conforming to GAAP (Generally Accepted Accounting Principals), IRC (Internal Revenue Code), OIJ (Office of the Inspector General), and other appraisal standards.

6. Strong and respected MD leadership in the medical and business community? MCO’s prefer to deal with physician executives with advanced degrees. You may not need a MBA or CPA, but you should be familiar with basic business, managerial and financial principals. This includes a conceptual understanding of horizontal and vertical integration, cost principals, cost volume analysis, financial ratio analysis and cost behavior?

7. Be willing to treat all conditions and types of patients. The adage,”more risk equates to more reward” is still applicable and most groups should take all the full risk contracting they can handle, providing they are not pooled contracts.

8. Are you a team player or solo act? The former personality type might do better in a group or MCO driven practice, while a fee for service market is still possible and may be better suited to the latter personality type.

9. Valid license, DEA narcotics license, CME, adequate malpractice insurance, board qualification/certification, hospital privileges, agree with the managed care philosophy, and have partners in a group practice that meet all the same participation criteria. Be available for periodic MCO review by a company representative.

Specific Medical Office Standards MCOs Desire

· Clean, presentable with a professional appearance.

· Readily accessible with barrier free design (OSHA).

· Appropriate medical emergency and resuscitation equipment.

· Waiting room to accommodate 5-7 patients with private changing areas.

· Adequate capacity (i.e., 5,000-10,000 member minimum), BP and office assistants for the plan.

· Office hour minimum (i.e., 20 hours/week)

· 24/7 on-call coverage with electronic tracking.

· MCO approved sub-contractors.

Assessment

Always remember, in the game of negotiations, today’s enemy – may be tomorrow’s ally.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: "Advisors Only", "Doctors Only", Book Reviews, Career Development, Health Insurance, Managed Care, Practice Management, Recommended Books | 1 Comment »

About: Healthcare Organizations [Financial Management Strategies]

Posted on April 11, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Our Print Mission Statement

[By Dr. David Edward Marcinko; MBA, CMP™]

Publisher-in-Chief

As Editor-in-Chief of a two volume – 1,200 pages – premium quarterly print journal, I am often asked about our mission statement; or the journal’s raison d’etra.

A Two-Volume Guide

As so, Healthcare Organizations: [Financial Management Strategies], with its quarterly updates, will promote and integrate academic and applied research, and serve as a multi-disciplined communications forum for the dissemination of financial, managerial, business and related economic information to decision makers in hospitals, outpatient centers, clinics, medical practices and all mature and emerging healthcare organizations.

Target Market and Ideal Reader

Healthcare Organizations [Financial Management Strategies] and its quarterly updates should be in the hands of all:

* CFOs, CEOs, COOs, CTOs, VPs and CIOs from every type of hospital and healthcare organization including: public, federal, state, Veteran’s Administration and Indian Health Services hospitals; district, rural, long-term care and community hospitals; specialty, children’s and rehabilitation hospitals; diagnostic imaging centers and laboratories; private, religious-sponsored, and psychiatric institutions.

* Physician Hospital Organizations, Management Services Organizations (MSOs), Independent Practice Associations (IPAs), Group Practices Without Walls (GPWWs), Integrated Delivery Systems (IDSs) and their administrators, comptrollers, cost accountants, budget directors, cash managers, auditors, healthcare attorneys and consultants, and actuaries, and all endowment fund directors, executives, consultants and strategic financial managers.

* Ambulatory care centers, hospices, and outpatient clinics; skilled nursing facilities, integrated networks and group practices; academic medical centers, nurses and physician executives; business school and health administration students, and all economic decision-makers and directors of allopathic, dental, podiatric and osteopathic healthcare organizations.

Assessment

After publication, my suggestion is to read, study and act upon the guide in this way:

1. First, browse through the entire text.

2. Next, slowly read those chapters and sections that are of specific interest to your professional efforts.

3. Then, extrapolate portions that can be implemented in specific strategies helpful to your healthcare setting.

4. Finally, use its’ ME-P updates as a reference manual to return to time and time again; and enjoy!

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Accounting, Book Reviews, Career Development, Drugs and Pharma, Ethics, Experts Invited, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, Inc., Information Technology, Managed Care, Practice Management, Practice Worth, Professional Liability, Recommended Books, Research & Development, Risk Management, Sponsors | Tagged: administrators, ASCs, CEO, CFO, children’s hospitals, clinics, community hospitals, COO, CXO, david marcinko, diagnostic imaging centers, DO, doctors, DPM, healthcare administration, Healthcare Organizations, hospital management, hospitals, Indian Health Services, laboratories, long term care, MD, medical journals, medical practice management, medical practices, nurse executives, nurses, oasteopaths, OD, office managers, outpatient centers, physicians, physisician executives, podiatrists, practice managers, psychiatric institutions, rehabilitation hospitals, RNs, rural hospitals, specialty hospitals, Veterans Administration | 1 Comment »

Enter Margaret Hamburg

Posted on April 10, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

The New FDA Nominee

By Staff Reporters

According to Tracy Staton and FiercePharma on April 7, Dr. Marcia Angell, former New England Journal of Medicine editor-in-chief and current Harvard Medical School lecturer, wrote a column in the Washington Post that set out a list of seven goals for Margaret Hamburg who awaits senate confirmation as FDA chief.

A New Book

Now, Angell has a particular point of view; she’s published a book called The Truth About the Drug Companies [How they Deceive us and What to Do About It]. Here they are, presented for your critique and consideration by the new FDA chief:

Repeal the Prescription Drug User Fee Act because it puts “the FDA on the payroll of the industry it regulates.”
Consultants for drug companies should be banned from advisory committees.
Enforce FDA mandates on post-marketing studies.
Review generics as quickly as it checks out branded meds.
Require drug-makers to compare their new drugs with similar existing meds.
Cease surrogate drug endpoints.
Bar DTC ads for three years after a new drug is approved.

Assessment

What has she missed? Are these guidelines fair or not? Will they be advocated by Hamburg, if confirmed?

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Filed under: Alerts Sign-Up, Book Reviews, Breaking News, Drugs and Pharma, Ethics, Health Law & Policy | Tagged: big-pharma, drug, drug companies, DTC, FDA, generic drugs, Marcia Angell, Margaret Hamburg, NEJM, pharma, pharmaceuticals, trade drugs, Washington Post | 1 Comment »

I Jealously “Shake my Fist” at Somnath Basu PhD

Posted on April 9, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

On CFP® Mis [Trust] – One Doctor’s Painful Personal Experience

[“So Sorry to Say it … but I Told You So”]

By: Dr David Edward Marcinko; FACFAS, MBA, CMP™

[Publisher-in-Chief]

According to Somnath Basu, writing on April 6, 2009 in Financial Advisor a trade magazine, the painful truth is that many financial practitioners are merely sales people masquerading, as financial planners [FPs] and/or financial advisors [FAs] in an industry whose ethical practices have a shameful track record. Well, I agree, and completely. This includes some who hold the Certified Financial Planner® designation, as well as the more than 98 other lesser related organizations, logo marks and credentialing agencies [none of which demand ERISA-like fiduciary responsibility]. For more on this topic, the ME-P went right to the source last month, in an exclusive interview with Ben Aiken; AIF® of Fi360.com

The CFP® Credential – What Credential?

Basu further writes that stockbrokers and insurance agents who earn commissions from buying and selling stocks, insurance and other financial products realize that a Certified Financial Planner® credential will help grow the volume of their business or branch them into other related and lucrative products and services. After all, there are more than 55,000 of these “credentialed” folks. And, this marketing designation seems to have won the cultural wars in the hearts and minds of an unsuspecting – i.e., duped public; probably because of sheer numbers. Didn’t a CFP Board CEO state that its’ primary goal was growth, a few years ago? Can you say “masses of asses”, as the oft quoted Bill Gates of Microsoft used to say when only 2,000 micro-softies defeated 400,000 IBMers during the PC operating system wars of the early 1980’s. Quantity, and marketing money, can trump quality in the public-relations business; ya’ know … if you repeat the lie often enough … yada … yada … yada! Yet, as the so-called leading industry designation, the CFP® entry-barrier standard is woefully low. Moreover, the SEC’s [FINRA] Series #7 general securities licensure sales examination is not worth much more than a weekend’s study attention, even to the uninitiated.

Easy In – Worth Less Out

In our experience, we agree with Basu and others who suggest that scores of lightly educated, and sometimes wholly in-articulate and impatient individuals are zipping through the CFP® Board of Standards approved curriculum in three to six months of online, on-ground, or “self-study”. But, that some can do so without a bachelor’s degree when they join wire-houses and financial institutions, which cannot be trusted to adequately train them, is an abomination. And, even more sadly, some of these CFP™ mark-holders, and other folks, believe they have actually received an “education” from same. Of course, their writing skills are often non-existent and I have cringed when told that, in their opinion, advertiser-driven trade magazines constitute “peer-reviewed” and academic publications. Incidentally, have you noticed how thin these trade-rags are getting lately? Much like the print newspaper industry, are they becoming dinosaurs? One agent even told me, point-blank, that his CLU designation was the equivalent of an “academic PhD in insurance.” This was at an industry seminar, where he thought I was a lay insurance prospect.

THINK: No critical thinking skills.

Education

There is another sentiment that may be applied in many of these cases; “hubris.” I mean, these CFP® people … just don’t know – how much they don’t know.” The very real difference between training versus education is unknown to many wire-houses and FAs, isn’t it? And, please don’t get me started on the differences in pedagogy, heutagogy and androgogy. Moreover, it’s sad when we see truly educated youngsters become goaded by wire-houses into thinking that these practices are de-rigor for the industry. One such applicant to our Certified Medical Planner™ program, for example, had both an undergraduate degree in finance and a graduate degree in economics from the prestigious Johns Hopkins University – in my home town of Baltimore, MD [name available upon request]. He was told, in his Smith Barney wire-house training program, to eschew CMP™ accountability and RIA fiduciary responsibility, when working with potential physician and lay clients; but to get his CFP® designation to gather more clients. To mimic my now 12 year-old daughter; it seems that: SEC Suitability Rules – and – Fiduciary Accountability Drools. And, to quote Hollywood’s “Mr. T”; I pity the fools, er-a, I mean clients. But, T was an actor, and this is serious business.

Of CEU Credits and Ethics

Beside trade-marks and logos, we are all aware that continuing education, and a code of ethics, is another important marketing and advertising component of state insurance agents and CFP licensees. It’s that old “be” – or “pretend to be” – a trusted advisor clap-trap. Well, I say horse-feathers for two reasons. First, both my insurance and CFP® Continuing Educational Unit [CEU] requirements were completed by my daughter [while age 7-10], by filling in the sequentially identical and bubble-coded, multiple-choice, answer-blanks each year. Second, this included the mandatory “ethics” portions of each test. When I complained to my CEU vendor, and state insurance department, I was told to “enjoy-the-break.” My daughter even got fatigued after the third of fourth time she took the “home-based tests” for me. After I opened my big mouth, the exact order of questions was changed to increase acuity, but remained essentially the same, nevertheless. My daughter got bored, and quit taking the tests for me, shortly thereafter. She always “passed.”

Thus, like Basu, I also find that far too many financial advisors are unwilling to devote the time necessary to achieve a sound education that will help attain their goals, and would rather sell variable or whole life products than simple term life, even when the suitability argument overwhelmingly suggests so, for a higher payday. We not only have met sale folks without undergraduate degrees, but also too many of those with only a HS diploma, or GED. Perhaps this is why a popular business truism suggests that the quickest way for the uneducated/under educated class to make big bucks, is in sales. Just note the many classified ads for financial advisors placed in the newspaper job-section, under the heading “sales.” Or, in more youthful cultural terms, “fake it – until you make it.”

Of the iMBA, Inc Experience

According to Executive Director Ann Miller RN MHA, and my experience at the Institute of Medical Business Advisors, Inc:

“Far too many financial advisors who contact us about matriculation in our online Certified Medical Planner™ program – in health economics and management for medical professionals – don’t even know what a Curriculum Vitae [CV] is? Instead, they send in Million Dollar Roundtable awards, Million Dollar Producer awards, or similar sales accomplishments as resume’ boosters. It is also not unusual for them to list some sort of college participation on their resumes, and websites, but no school affiliation or dates of graduation, etc. And, they become furious to learn that we require a college degree for our fiduciary focused CMP™ program, and not from an online institution, either. The onslaught of follow-up nasty phone-calls; faxes and emails are laughable [frightening] too.”

www.MedicalBusinessAdvisors.com

Assessment

More often than not, it is the financial institutions that FAs and CFP™ certificants’ work for that reward sales behavior with higher commissions, rather than salaries; which encourage such behavior and create the vicious cycles that are now the norm.

THINK: ML, AIG, Citi, WAMU, Wachovia, Hartford, Prudential, etc.

Note: Original author of Restoring Trust in the CFP Mark, Somnath Basu PhD, is program director of the California Institute of Finance in the School of Business at California Lutheran University where he’s also a professor of finance. He can be reached at (805) 493 3980 or basu@callutheran.edu. We have asked him to respond further.

My Story: I am a retired surgeon and former Certified Financial Planner® who resigned my “marketing trademark” over the long-standing fiduciary flap. I watched this chicanery for more than a decade after protesting to magazines like Investment Advisor, Financial Advisor, Registered Rep, Financial Planner, the FPA, etc; up to, and even including the CFP® Board of Standards; to no avail. Feel free to contact me for a copy of a 43 page fax, and other supportive documentation from the CFP® Board of Standards – and their outsourced intellectual property attorneys – over a Federal trademark infringement lawsuit they tried to institute against me for innocent website errors placed by a visually impaired intern. Obviously, they disliked the launch of our CMP™ program. As a health economist and devotee of Ken Arrow PhD, I polity resigned my license, as holding no utility for me, to the shocked CFP Board. They later offered to consider re-instatement for a mere $600 fee with letter of explanation, to which I politely declined. Of course, my first thought after living in the streets of South Philadelphia while in medical school, during the pre-Rocky era, was to say f*** off – but I didn’t. Nevertheless, I still seem to be on their mailing list, years later. No doubt, the list is sold, and re-sold, to various advertisers for much geld. And, why shouldn’t they; an extra bachelor, master and medical degree holder on their PR roster looks pretty good. I distrust the CFP® Board almost as much as I distrust the AMA, and its parsed and disastrous big-pharma funding policies. Right is right – wrong is wrong – and you can’t fool all of the people, all of the time, especially in this age of internet transparency.

Shaking my Fist at Somnath … in Envy

And so, why do I shake my fist at Somnath Basu? It’s admittedly with congratulations, and a bit of schadenfreude, because he wrote an article more eloquently than I ever could, and will likely receive much more publicity [good or slings-arrows] for doing so. You know, it’s very true that one is never a prophet in his own tribe. Oh well, Mazel Tov anyway for stating the obvious, Somnath. The financial services industry – and more specifically – the CFP® emperor have no clothes! Duh!

Good Guys and White Hats

Now that Basu’s article has appeared in Financial Advisor News e-magazine, the other industry trade magazines are sure to follow the CFP® certification denigration reportage, in copy-cat fashion. And, the fiduciary flap is just getting started. This is indeed unfortunate, because I do know many fine CFP® certificants, and non-CFP® certified financial advisors, who are well-educated, honest and work very diligently on behalf of their clients. It’s just a shame the public has no way of knowing about them – there is no white hat imprimatur or designation for same – most of whom are Registered Investment Advisors [RIAs] or RIA reps. For example, we know great folks like Douglas B. Sherlock MBA, CFA; Robert James Cimasi MHA, AVA, CMP™; J. Wayne Firebaugh, Jr CPA, CFP®, CMP™; Lawrence E. Howes MBA, CFP®; Pati Trites PhD; Gary A. Cook MSFS, CFP®, CLU; Tom Muldowney MSFS, CLU, CFP®, CMP™; Jeffrey S. Coons PhD, CFP®; Alex Kimura MBA, CFP®; Ken Shubin-Stein MD, CFA; and Hope Hetico RN, MHA, CMP™; etc. And, to use a medical term, there are TNTC [too many, to count] more … thankfully!

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: "Advisors Only", Breaking News, Career Development, CMP Program, Ethics, Experts Invited, Financial Planning, iMBA, Inc., Insurance Matters, Investing, Op-Editorials, Practice Management, Recommended Books, Sponsors | Tagged: American College, ann miller, annuities, Basu, Bill Gates, certified financial planner, certified medical planner, certifiedmedicalplanner.com, CEU, CFP, CFP Board of Standards, Cimasi, Citi, CLU, CMP, Coons, david marcinko, ERISA, fiduciary, financia services industry, financial advisor, financial advisors, financial planners, financial sales, Firebaugh, FPA, GED, Hartford, HealthcareFinancials.com, healthDictionarySeries.com, hope hetico, IBM, insurance agents, investment advisor, JFPA, Johns Hopkins, Ken Arrow, Ken Arrow PhD, Kimura, life insurance, medicalbusinessadvisors.com, million dollar roundtable, ML, Muldowney, PhD, prudent man, Prudential, Registered Rep, SEC, Series 63, Series 65, Series 7, Sherlock, Shubin-Stein, Smith Barney, Somnath Basu, stockbrokers, suitability, Trites, variable annuities, Wachovia, WAMU, whole-life, wirehouse | 51 Comments »

Social Media in Health 2.0

Posted on April 9, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Emerging Collaborative Trends

[By Staff Reporters]

All readers of the ME-P are aware that social media is going to play a significant role in health 2.0 initiatives going forward.

Social Media Use Growing

According to Dan Bowman of FierceHealthIT, on April 3, 2009, whether we want it to happen or not, social media – much like mobile technology – is going to play a big role in the future of healthcare. From professional networks, to collaborative consumer media and doctor rating websites, healthcare professionals across the nation are jumping on the bandwagon. And, with the federal government pushing physicians’ offices to utilize electronic medical records, it is only a matter of time before healthcare make a concerted push into social media, as well.

Publishers and Editors

“As a medical, practice management and health economics writer for almost four decades, I appreciated how electronic connectivity and social media facilitates communication in a quick and effective manner, and allows broadcast to large groups of people”

Dr. David Edward Marcinko; MBA

[ME-P Publisher-in-Chief]

The Research

A Manhattan Research survey found that 60 million US healthcare consumers use social media to find healthcare information online. A similar survey found that 60 percent of physicians are interested in, or are already using physician social networks. That same study concluded that “physicians who are currently participating in online physician communities and social networks write a mean of 24 more prescriptions a week than” their more old-fashioned counterparts.

Assessment

Of course, more Rxs – or more medical care for that matter – is not a quality indicator at all. Nevertheless, social media is not to be taken lightly.

Link: http://www.fiercehealthit.com/tags/ozmosis?utm_medium=nl&utm_source=internal&cmp-id=EMC-NL-FHI&dest=FHI

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

Filed under: Career Development, Experts Invited, Glossary Terms, iMBA, Information Technology, Managed Care, Marketing & Advertising, Practice Management, Quality Initiatives, Research & Development | Tagged: blogs, cloud, cloud computing, collaborative healthcare, computers, email, gird, grid computing, hardware, health information technology, HIT, IT, networks, online, online healthcare, PCs, social media, software, websites, wikis | 7 Comments »

Impact of Size on Mutual Fund Performance

Posted on April 8, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Vital Information for Doctors to Consider

[By Dr. David Edward Marcinko; FACFAS, MBA, CMP™]

[By Professor Hope Rachel Hetico; RN, MHA, CMP™]

The actual size of a mutual or index fund, in terms of amount of assets, and the growth rate of a fund are the two aspects of size to consider. The impact of size on mutual fund performance varies—it can be negative, neutral, or positive. Size affects different types of funds differently; it also affects the manager’s ability to achieve objectives. Monitor size changes and make investment decisions accordingly.

Economies of Scale

A relatively large amount of assets available to a portfolio manager presents various economies. The costs at most funds (e.g., expense ratios) are reduced as a percentage of net asset value as the fund grows. Expense ratios can have a major impact on performance. In addition to being an effect of size, low fees can cause size changes. Funds do at times waive some fees to attract assets.

Asset Base

A larger asset base provides more liquidity to a fund. With more assets, the manager can buy more shares and more stocks. Transaction costs are reduced if higher trading volumes are achieved. A larger asset base also can reduce relative tax costs. Realized but undistributed capital gain can be spread over more shares at the time of year-end distribution. A larger asset base and manager success attracts higher-caliber managers to the management team.

Fund Growth

Growth of fund assets impairs certain funds more than others. Generally, bond funds are less affected by asset growth and size than equity funds. Growth may have a positive impact on bond funds because buying bonds of similar characteristics further diversifies credit, event, and other risks. Equity funds that invest in larger capitalization stocks can be less affected than funds buying less liquid small-cap stocks. (This is so because funds usually limit their investments in a single company, i.e., many funds will not buy more than 5% of a specific company. Five percent of a small company uses up less cash than 5% of a large company. Therefore, a small-cap fund is more likely to exhaust its choice of available companies sooner than a large-cap fund. A large-cap fund could increase its investment to a 5% level, whereas a small-cap fund may already be fully invested in the companies the manager likes to own.)

Growth Rate

The rate of growth can affect performance. Rapid growth may mean that a large portion of the portfolio remains un-invested. A rapidly growing growth-type equity fund with a high percentage of cash earns lower returns in a rising market than a fully invested fund. With rapid growth, the fund may not provide pure exposure to the desired asset class. At a certain point, however, fund asset growth impairs the manager’s ability to achieve objectives. For this reason, funds often close to new investors or to new investment once they have reached a certain size. Growth affects managers in many ways. Many fund managers or teams of managers direct a number of funds and possibly even private accounts. As the fund grows, managers are spread thin and may have difficulty in reacting quickly or efficiently to changing market conditions. Managers may need to hire assistant portfolio managers or delegate work to analysts or other employees. As a result, the manager manages people, administration, or internal quality control systems rather than studying companies or investment strategies. Also, a manager may become complacent in periods of rapid asset growth. Such growth can mean their own compensation is substantially greater, which may in turn change the manager’s motivation. Rapid growth often changes a fund because there are not enough opportunities to invest in the targeted securities. For example, a fund can change from aggressive to conservative, small cap to large cap. Managers may have to slow trading or increase liquidity in the portfolio to prevent this occurrence.

Meaningful Positions Difficult

Rapid growth or a large asset base can prevent managers from taking meaningful positions in market sectors they believe will outperform others. Smaller funds are more flexible and may take advantage of opportunities or liquidate unwanted positions faster than larger funds. A large fund that owns a significant position will negatively affect a security’s market price if it unloads shares all at one time. Rapid growth also impairs research of funds, affecting an investor’s choice of funds. A fund with outstanding performance over the past 5 years and a $150 million asset base may be much different when its base grows to $1 billion; at that point, it may no longer be the “right choice” for an investor.

Asset Declinations

Just as rapid asset growth affects performance, a rapid decline of fund assets also may impact performance. Significant quantities of redemptions over short periods force managers to liquidate security positions, often at the wrong time (i.e., they would rather be buying in a declining market than selling to accommodate redemptions). To prevent this scenario, some funds have redemption charges to discourage investors from such short-term decisions. Such environments can negatively impact bond funds as easily as equity funds. Large redemptions compound the effect of declining fund net asset values.

What a Doctor-Investor Can Do?

What can physician-investors do to avoid negative effects on investment? Avoid overloading a portfolio with hot, rapidly growing funds, if possible. Generally, size should be a neutral factor for most bond funds. Small and/or aggressive equity funds can be affected by growth, however. Emphasize funds that promise to close to new investors after assets reach a certain size. Once a fund becomes large, monitor it closely for problems caused by the growth. If there is a better, smaller fund, it may be wise to change. Also, closed-end funds are always a possibility. These funds have a major advantage in that their asset base is a factor of growth in security values, not new investment (unless the fund makes a secondary stock offering). Closed-end managers work with a finite portfolio, which reduces the problem of sudden asset growth.

Assessment

To the extent that a lack of SEC and FINRA over-sight, and the recent financial, insurance and banking meltdown has affected the above; such investing is left up to the doctor’s discretion and personal situation. When it comes to the financial services product sales industry; always remember “caveat emptor” or “buyer-beware.”

Disclaimer: Both contributors are former licensed insurance agents and financial advisors.

Conclusion

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Filed under: Experts Invited, Financial Planning, iMBA, Inc., Insurance Matters, Investing, Media Mentions and PR, Op-Editorials, Portfolio Management, Recommended Books, Risk Management, Taxation | Tagged: CFP, CMP, CPA, david marcinko, DDS, DO, DPM, financial advisors, Financial Planning, fund assets, fund costs, fund expenses, fund growth, fund managers, fund size, hope hetico, index fund, index fund size, Investing, MD, mutual fund expenses, mutual fund performance, mutual fund size, OD, physician investors | 2 Comments »

NCHIT’s Bob Kolodner to Retire

Posted on April 8, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

National Co-ordinator of Heath IT Exits

By Staff Reporters

According to Government Health IT [HIMSS publication] and Paul McCloskey, Dr. Robert Kolodner, National Coordinator of Heath IT [NCHIT], said he would retire from federal service after a 30-year career during which he led the effort to build a working foundation for national health information sharing.

Enter David Blumenthal, MD

Kolodner will retire once his successor, Dr. David Blumenthal, was ready to take over the office. He will explore a range of opportunities for working in health IT after leaving government.

Assessment

Link: http://govhealthit.com/articles/2009/04/06/kolodner-to-retire-from-federal-government.aspx?s=GHIT_070409

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? What do you think of the Kolodner era and legacy? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Filed under: Breaking News, Information Technology, Quality Initiatives | Tagged: David Blumenthal, Government Health IT, health information technology, HIPAA, National Coordinator of Heath IT, NCHIT, Robert Kolodner | 3 Comments »

Our Business Model and Publishing Ethos

Posted on April 7, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

On our Ethics and Advertising Policy

By Dr. David Edward Marcinko; FACFAS, MBA, CMP™

[Publisher-in-Chief]

Thanks to the internet, doctors and medical professionals have direct access to potential patients, while financial advisors and management consultants have direct access to potential clients. So, linking these inter-related factions on the Medical Executive-Post is our raison d’etra. Throw in their penchant to opine, act as citizen journalists and compete free-lance style; and you get a lively and novel kind of business formed around these free-labor reporters, experts and new-media entrepreneurs.

www.MedicalBusinessAdvisors.com

What we Do

The ME-P provides an unbiased forum, exposure platform, and voice for our contributors. We are a healthcare consulting grid, with a new media collective intelligence publishing network for industry professionals seeking brand name exposure, test market acceptance and concept validation. We offer industry essays, insider columnists, interviews, case models, news reportage, and gossip; and moderated business forums with comments. We also aggregate niche articles and pertinent videos across the web, in a limited fashion. We have three part-time employees, ICs, and a host of dedicated volunteers.

New Media

Moving into new media may seem an odd step given the collapse of the print publishing business today, and the carnage inflicted on both the healthcare space and financial services sector. But, as a privately held subsidiary, we are not after media business. We don’t sell ads on the site. You won’t see any Google references, automated Adsense or other electronically generated classifieds, here. However, we may run promotions for selected business and strategic alliance partners. We do offer our own consulting services, and sell our own textbooks, handbooks, dictionaries and institutional print guide. We also promote our online education certification program – Certified Medical Planner™ – for financial advisors interested in the healthcare niche space. THINK: Doctor-Advisor-Administrator-Journalist-Consultant. But, all of these activities of course, predate the blog site.

Not Profit Driven

In other words, we are not a profit generating enterprise. Rather, we want to lead the professional discourse concerning the myriad of issues our business subsidiaries revolve around. To avoid issues of favoritism, we draw the line at product news and reviews. But, we do blog, opine, rant and rave to draw business to our portfolio of companies, and encourage other professionals and experts to do the same.

Assessment

Rest assured – our loyalties are clear. First to medical professional and the healthcare space; then to physician focused and fiduciary financial advisors; and finally to medical practice management and business consultants; in that prioritized order.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites. Then, subscribe to the ME-P. It is fast, free and secure.

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Subscribe Now:Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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Filed under: Alerts Sign-Up, Ethics, iMBA, Inc., Marketing & Advertising, Media Mentions and PR, Op-Editorials, Sponsors | Tagged: Certified Financial Planners, david marcinko, DO, DPM, executives, hope hetico, MD, Medical Executve-Post, nurses, OD, physicians, www.certifiedmedicalplanner.com, www.healthcarefinancials.com, www.healthdictionaryseries.com, www.medicalbusinessadvisors.com | Leave a comment »

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